Introduction

This quality standard covers assessment, early management and rehabilitation following head injury in children, young people and adults. For more information see the head injury overview.

Why this quality standard is needed

Head injury is any trauma (external force) to the head other than superficial injuries to the face. NICE's guideline on head injury notes that it is the most common cause of death and disability in people aged 1–40 years in the UK. The guideline also reports that 1.4 million people per year attend accident and emergency departments in England and Wales with a recent head injury and that 33–50% of these are children and young people aged under 15 years.

Most people recover from head injury without specific or specialist intervention, but others experience long‑term disability or even die from complications that could be minimised or avoided with early detection and appropriate treatment. Early detection and rapid treatment is therefore vital for minimising the risk of disability and saving lives.

Emergency departments see many people with minor head injuries and need to identify the very small number of people with head injuries who will go on to have serious acute intracranial complications. CT scanning is the primary imaging modality for assessing head injury. Admission to a specialist centre may be needed for continued observation and surgical intervention.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality after head injury

  • recovery after head injury.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:

Tables 1–3 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 The Adult Social Care Outcomes Framework 2014/15

Domain

Overarching and outcome measures

2 Delaying and reducing the need for care and support

Outcome measure

2B Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services*

Aligning across the health and social care system

* Indicator shared with NHS Outcomes Framework (NHSOF)

Table 2 NHS Outcomes Framework 2014/15

Domain

Overarching indicators and improvement areas

3 Helping people to recover from episodes of ill health or following injury

Overarching indicator

3b Emergency readmissions within 30 days of discharge from hospital**

Improvement areas

Improving recovery from injuries and trauma

3.3 Survival from major trauma

Helping older people to recover their independence after illness or injury

3.6ii Proportion offered rehabilitation following discharge from acute or community hospital*

4 Ensuring that people have a positive experience of care

Overarching indicator

4b Patient experience of hospital care

Improvement areas

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to inpatients' personal needs

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

Alignment across the health and social care system

* Indicator shared with Adult Social Care Outcomes Framework (ASCOF)

** Indicator shared with Public Health Outcomes Framework (PHOF)

Table 3 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.11 Emergency readmission within 30 days of discharge from hospital*

Aligning across the health and social care system

* Indicator shared with NHS Outcomes Framework (NHSOF)

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to head injury.

NICE has developed guidance and associated quality standards on patient experience in adult NHS services and service user experience in adult mental health services (see the NICE pathways on patient experience in adult NHS services and service user experience in adult mental health services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development source(s) for quality standards that impact on patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for head injury specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole trauma care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people with a head injury.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing high‑quality trauma services are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health, public health and social care practitioners involved in assessing, caring for and treating people with a head injury should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with a head injury. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.