Protocol in Practice: Impact of Brain Herniation Code Alerts at a Tertiary Level Medical Center

Brain herniation is a life-threatening condition due to increased intracranial pressure. Timely intervention is essential to improving outcomes. Brain herniation code alerts (BHCA) were instated at our institution to streamline management. We launched a quality initiative to increase protocol utilization and reduce intervention time.

Educational sessions were held for house staff (e.g., surgery, medicine, neurology residents, advanced practice providers) with pre-educational and post-educational surveys. BHCA were reviewed retrospectively: 38 pre-education and 15 post-education. We measured time to head computed tomography (CTH), hyperosmolar therapy, Glasgow Coma Scale (GCS), and in-hospital mortality.

House staff assessments improved after educational sessions ( p < .001). They correctly activated BHCA in 100% of post-education cases (vs. 18.4% pre-education). Time to CTH was similar (pre: 35.7 ± 6.42 minutes; post: 41.9 ± 6.36 minutes). Time to hyperosmolar therapy trended toward faster administration (pre: 20.5 ± 2.5 minutes; post: 13.67 ± 2.03 minutes, p = .05). No significant differences were found in GCS or mortality ( p > .05).

Providers had better understanding of BHCA due to education sessions, increasing BHCAs called and improving time to medication administration.

Brain herniation syndromes are rare but have high mortality if not treated immediately. A streamlined process is critical for rapid diagnosis, resource mobilization, and timely intervention. Ongoing system improvements and staff education can reduce errors and improve outcomes.