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  • Implementation of a Nurse-Driven Hotline and Emergency Department Observation Protocol For Management of Mild TBI Patients

    Final Number:

    Laura Benjamin Ngwenya MD, PhD; Katherine Rhame; Diana Le; Amy Horner; Opeolu Adeoye; Norberto O. Andaluz MD; Natalie Kreitzer

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: There are 2.5 million emergency department (ED) visits, 282,000 hospitalizations, and 56,000 deaths related to traumatic brain injury (TBI) each year in the United States (US). Over 80% present with a Glasgow Coma Scale (GCS) score of 13-15, an injury that is characterized as mild. The prognostic uncertainty of CT-identified intracranial hemorrhage in this mild patient population has resulted in wide variations in patient management. Our institution has developed and implemented an observation protocol for patients with complicated mild TBI. This protocol relies upon appropriate patient follow up and resources, including a nurse-led neurotrauma hotline specific to the needs of TBI patients.

    Methods: We retrospectively reviewed calls to the neurotrauma hotline over an 18-month period (January 2016 to June 2017). In addition to patient demographic information and utilization of our observation protocol, we describe caller demographics, the needs of the callers, whether the call was answered live, and the outcome of each call.

    Results: Over an 18-month period, there were 1,742 calls to the hotline, with 388 repeat callers, representing 1,354 unique patients. Of those, 58.1% were male, and median age was 40 years. The majority of calls were regarding patients who had been discharged from the emergency department or had been admitted to the observation protocol. Calls were answered live 30.3% of time. Calls were from patients, family or friends, internal providers, or outside providers (Figure 1). The purpose of the call was most frequently for advice or for an appointment (Figure 2).

    Conclusions: There was widespread utilization of our nurse-driven neurotrauma hotline. The neurotrauma hotline facilitated TBI patient navigation through our hospital and outpatient system. Other institutions may wish to adopt similar practices for best resource utilization, and can expect that the majority of hotline calls will be for appointment scheduling or clinical advice.

    Patient Care: Adopting observation protocols for TBI patients can optimize resource utilization while facilitating patient navigation through the hospital system.

    Learning Objectives: By conclusion of this presentation, participants should be able to: 1) Identify strategies in management of complicated mild TBI patients, 2) Understand the utility of a nurse-driven neurotrauma hotline, 3) Learn effective resource utilization for TBI patients


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