Shared learning database

Type and Title of Submission


Refining and standardising head injury care in Salisbury




Does the submission relate to the general implementation of all NICE guidance?


Does the submission relate to the implementation of a specific piece of NICE guidance?


Full title of NICE guidance:

CG56 - Head injury

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?


Description of submission


To refine and standardise the care of patients attending our Trust with head injury ensuring timely and appropriate skilled assessment, timely, appropriate and equitable access to CT scanning and holistic inpatient care including follow up and rehabilitation.


To reduce risks in this high risk group by implementing our aims using the NICE guidance as both the catalyst and core of our new system of care. Moving from traditional models of inpatient ownership of this patient group (under the nominal care of General surgeons) to the care of specialists with higher training in the acute management of head injury and frequent exposure to this patient group (emergency physicians). To link directly with follow up services and rehabilitation directly avoiding excessive unnecessary steps and process delays.


Management of head injury in our trust was in line with traditional models. Assessments were of variable quality, the use of diagnostics also varied by time of day and day of week. In-patient review also varied in both its frequency and quality. Variation like this increases risk. Within 12 months we had undertaken one Clinical Review and one Serious Incident Enquiry relating to patients presenting with head injury. These two enquiries highlighted the variability previously described. Implementation of the NICE CG56 in its entirity (as rules in effect) along with reorganising the care pathway for these patients was needed.


1) Cross department cooperation was obtained with emergency medicine, radiology, Stroke and rehab medicine and general surgery.
2) The Guidance was successfully adopted ensuring equity of timely access to CT scanning for all patients meeting the criteria 24 hrs per day. Importantly the need to speak with on call radiology to approve the scan was removed taking pressure off the emergency department and Hospital at Night junior medical staff.
3) Emergency physicians have taken over the inpatient care of this group responsible for the holistic care of the head injury for the first 48 hours of the admission then referring directly on to the Trust's stroke and rehabilitation consultant.
4) Since implementation there have been no governance issues related to head injury care.

Results and evaluation

Baseline audit was carried out pre implementation (May- August 2005. Subsequent audits were carried out over the same 4 month period in 2006 and 2007) These audits showed sustained improvement in meeting the CG56 guidance with, after subtle changes to our processes met indicators now above 85% in all areas. Audit for 2008 is underway.

Results are available within the Trust and have been presented at board level. We do not intend to publish wider than this as work of this sort has been published numerous times before.

Key learning points

Leadership and championing the cause are crucial components to achieving a Trust wide change in care like this. Cooperation between departments, mutual respect and trust are needed too. Demonstrate the need for the change in the most objective way possible. Plan properly including monitoring and evaluation components. Have broad shoulders and accept that there will be times when others may be sceptical of the project and its chances of success. Small gains early in the project usually foster greater cooperation and a sense of ownership that the problem belongs to all of us.

View the supporting material

Contact Details

Name:Neil Robinson
Job Title:Consultant in Emergency Medicine
Organisation:Salisbury NHS Foundation Trust
Address:Odstock Rd
Postcode:SP2 8BJ
Phone:01722336262 ext4839


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This page was last updated: 31 July 2008

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.