CT head requests – Are they clinically indicated? A QIP conducted in Acute Frailty Unit(AFAU) at Princess Royal University Hospital

Poster Title: CT head requests – Are they clinically indicated?  A QIP conducted in Acute Frailty Unit (AFAU) at Princess Royal University Hospital.

Aim:
1. To find out how many inpatient CT heads are being completed for patients reviewed at AFAU.
2. To assess the main indications for requesting a CT head.
3. To assess how many CT heads were not clinically indicated, and to explore if there are any particular reasons why non-indicated scans are being done.
4. To identify areas of improvement in relation to CT head requests.
5. To improve the CT head request practice to 90% in a period 3 months.   

Methodology:
Patient selection: all patients reviewed in AFAU in June 2022 (n= 132) and January 2023 (n=143).
 
June constituted our baseline data and January 2023 was the 1st PDSA cycle
 
The EPR CT head request forms were reviewed, and the data copied in an excel spreadsheet. The medication history at the time of admission was reviewed in order to confirm if the patients were on anticoagulation.

Baseline results:
1. 4 CT head request forms referred to head Injury whilst on anticoagulation, however on review the patients were not on anticoagulants.
2. None of the CT head requests querying stroke provided information on focal neurological deficit, stroke requests included only ‘slurred speech’ or ‘dizziness’ or ‘new onset weakness’ (site/side unspecified).

Conclusions:
1. This QIP has shown a large improvement in the CT head request practice.
2. Our PDSA interventions were easy to implement and several areas were identified for further improvement.
3. Although the CT head request standards consistently improved, we did not achieve the overall 90%. This suggests that additional interventions are required.

QIP methods
1. Baseline results were communicated at the Geriatrics weekly teaching meeting and NICE guidelines were revisited.
2. Educational announcement at ED and Visual prompt of NICE CT head guidelines placed in ED

Recommendations
   1. Further teaching sessions on the latest NICE guidelines for the indications of CT head.
   2. Additional Posters, particularly in A&E where most scans are ordered.
   3. EPR CT head request form can be updated to include NICE guidelines sections

Abstract (max 250 words)