Consistent traumatic brain injury screening improves outcomes for patients in Counties Manukau

A project team at Te Whatu Ora Counties Manukau has improved the accuracy of assessments for patients with possible amnesia following traumatic brain injury.

Patients with traumatic brain injury can be admitted to one of several wards at Te Whatu Ora Counties Manukau. This means assessments were being performed by a range of staff who had different levels of understanding about how to assess patients for post-traumatic amnesia (PTA).  

The project team, part of the Health Quality & Safety Commission’s trauma rehabilitation national collaborative, aimed to improve the accuracy rates of assessment for PTA by upskilling staff on acute wards. They wanted staff to better understand the assessment process and confidently perform an assessment on patients who met the criteria for a traumatic brain injury (TBI). 

Incorrect assessment increases the risk of missing diagnoses of concussion or more serious traumatic brain injuries. This can result in some patients not getting the hospital care they need, and not being referred to the correct support services in the community on discharge.

When assessing a patient for PTA, a national TBI toolkit is used to make sure the patient is assessed correctly and an accurate result is obtained. During the collaborative, the project team chose to focus on one tool – the Westmead PTA scale.

Their data showed there were inaccuracies in the way assessments were performed, with the most common errors being:

• a delay in starting the assessments
• using the wrong assessment tool and/or using the tools incorrectly
• incomplete documentation.

The team developed resources to educate staff about how to complete assessments accurately and delivered education to occupational therapy staff working on acute wards. 

The results of a detailed clinical audit informed a new e-learning module to educate all clinicians involved in the assessment of TBI and concussion, and give them consistent information. The module is now available through Ko Awatea LEARN, Te Whatu Ora Counties Manukau’s e-learning platform, and is being rolled out through the Commission’s serious TBI collaborative. 

Standardised resources were developed and are available in all wards where staff complete PTA assessments. This has created a standardised approach across the hospital.

Feedback from staff has been positive, with many commenting about the ease of completing the assessments now there is a clearly documented process in place. 

In 2021, the trauma rehabilitation national collaborative brought together 11 teams of rehabilitation clinicians from across Aotearoa New Zealand to complete quality improvement projects that would improve outcomes for patients’ rehabilitation after major trauma. The collaborative is part of a broader programme of work by the National Trauma Network, Accident Compensation Corporation and the Health Quality & Safety Commission to establish a contemporary system of trauma care in Aotearoa New Zealand.

Find out more about the programme on our website and read the full case study from Te Whatu Ora Counties Manukau below.