Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative.

Area of Science:

• Neuroscience
• Critical Care Medicine
• Quality Improvement

Background:

• Frequent neurological assessments are vital for detecting deterioration in acquired brain injury patients.
• Hourly neuro-checks can lead to sleep deprivation, ICU delirium, and increased staff burden.
• Optimizing neuro-check frequency is crucial for patient well-being and efficient care.

Purpose of the Study:

• To evaluate a nurse-driven protocol for reducing unnecessary hourly neuro-checks in stable Neurocritical Care Unit patients.
• To assess the impact of individualized neuro-check frequency on patient outcomes and staff workflow.
• To improve the quality of care in Neurocritical Care Units through protocol implementation.

Main Methods:

• Implementation of a stepwise, nurse-driven protocol based on patient stability criteria in an academic medical center's NCCU.
• Utilized electronic health records to collect pre- and post-implementation data on neuro-check order volumes, CAM-ICU scores, and length of stay.
• Gathered staff perceptions of the protocol via surveys to assess workflow and confidence.

Main Results:

• Hourly neuro-check orders decreased by 19% (372 to 301) during the 3-month implementation.
• The proportion of patients with positive CAM-ICU scores decreased from 39.8% to 31.7%.
• Observed trends of fewer very short (<2 days) and prolonged (>9 days) admissions; staff reported increased confidence and improved workflow.

Conclusions:

• A nurse-led protocol successfully individualized neuro-check frequency in the NCCU.
• The protocol showed positive trends in patient outcomes, staff efficiency, and nursing confidence.
• Further evaluation is needed to confirm sustainability and generalizability to other critical care settings.