CT Head Imaging Within 60 Minutes of Arrival at the ED: A Clinical Audit

Objective This audit aimed to assess current compliance with the National Institute for Health and Care Excellence (NICE) NG232 guideline and evaluate the impact of introducing a triage pro forma to nurses to improve the time from patients' arrival in the Emergency Department (ED) to CT head imaging in eligible patients.  Method  A retrospective clinical audit was conducted over two cycles at the ED of a UK District General Hospital. It included patients at the ED who underwent CT head imaging. Non-trauma-related indications and patients under the age of 16 years were excluded. The first cycle, using Electronic Patient Records (EPR), reviewed 138 patients from 20 September 2023 to 20 October 2023. A pro forma was then introduced to assist triage nurses in identifying eligible patients, ensuring they were promptly assessed by a clinician, and imaging was requested. Daily educational sessions were conducted from 20 October 2023 to 3 November 2023, along with email dissemination and handover reinforcement. The second cycle was conducted from 3 November 2023 to 15 November 2023 and included 87 patients, with their data collected from EPR.  Results  In the first cycle, 4.34% (n=6) of patients received imaging within 60 minutes, which is suboptimal. In the second cycle, the proportion of imaging completed within 60 minutes increased to 6.9% (n=6), and this incremental increase is significant (p <0.05).  Conclusion The introduction of the triage pro forma resulted in incremental improvements in timely brain imaging, and, therefore, the intervention showed significant positive potential in enhancing adherence to national guidelines and improving patient outcomes. Challenges such as staff compliance, patient transfer time, and workload do influence this, and those are areas that need further improvement. This project has the potential to be implemented across multiple trusts.