Project leads to brain injuries being proactively identified

In Aotearoa New Zealand assessment of traumatic brain injury (TBI) in patients admitted to hospital with major trauma was inconsistent, inequitable and was in places very limited.

If left undiagnosed, a TBI can affect long-term outcomes including delays in functional recovery and reductions in quality of life. Early identification enables patients to get the care and rehabilitation they need to support their recovery.

In 2022, 55 percent of surveyed trauma clinical teams reported major trauma patients were likely to be discharged home without brain injury assessment. Forty percent of hospitals also reported having no systematic processes for identifying patients with a TBI.

This prompted a national improvement campaign led by Te Tāhū Hauora Health Quality & Safety Commission, the Trauma National Clinical Network and the Accident Compensation Corporation (ACC).

Establishing a national serious TBI quality improvement collaborative

Nine project teams from hospitals across the motu participated in a national serious TBI quality improvement collaborative. The aim was to improve identification of TBI by conducting post-traumatic amnesia (PTA) assessments for major trauma patients, to ensure all brain injured patients receive timely rehabilitation.

PTA duration is a well-known indicator of injury severity and a predictor of functional outcome in those who sustain TBI. The duration of PTA is also used by hospitals and ACC to determine the severity of TBI and the rehabilitation services required.

Positive results from the collaborative

A review has found that the TBI collaborative has resulted in lasting service improvement initiatives that have optimised the assessment of brain injury for the most seriously injured New Zealanders.

It found that, at the collaborative sites, high volumes of  major trauma patients are being appropriately assessed - ensuring that brain injuries are being identified earlier in the care journey.

In the first year (2022 and 2023) of collecting the PTA data point (which was also during the time the collaborative was running), median PTA assessment for collaborative sites was 75 percent, compared with 66 percent for non-participating sites. Between November 2023 and April 2024 results increased to 84 percent for collaborative sites, compared to 68 percent for non-collaborative sites.

Identifying lasting service improvements

Simple and cost effective solutions used by teams to introduce new processes, while reducing the burden of work on busy staff, included:

• placing visual reminders on hospital computer screensavers and in wards
• adding checklists to existing essential assessment tools (such as the trauma tertiary survey)
• embedding the TBI pathway into electronic clinical records.

Work is now underway to connect with teams at hospitals which weren’t part of the collaborative to share resources and support their local improvement initiatives.

Find out more about the progress made by the serious traumatic brain injury collaborative