None listed
Conditions
Brief summary
Head injury is a very common presentation to emergency departments (EDs). Up to 15% of patients with mild head injury experience persistent disabling problems (e.g. reduced cognitive and functional ability, heightened emotional distress, and delayed return to work or school). As the ED is the main, and often only, point of medical contact for these patients, the care they receive in the ED can impact on these patients’ outcomes. The NET-Trial is a cluster randomised trial which aims to test the effectiveness of a targeted, theory and evidence-informed implementation intervention regarding the management of adult mild head injured patients in the ED in Australia. Three recommendations from clinical practice guidelines have been selected as the focus of the study and they are 1) prospective assessment for post traumatic amnesia (PTA) using a validated tool; 2) appropriate computed tomography (CT) scanning based on risk criteria; and 3) the provision of patient information upon discharge from the ED. The 3 key evidence-based recommendations have been decided after a systematic review of the evidence and available clinical guidelines, and consultation with the ED community. EDs will be randomised to receive either the intervention or to a control group who will have access to the clinical practice guideline alone. The control group will be offered to receive the intervention component of the study following data collection. In addition, EDs will be invited to participate in the “NET-Plus” trial that also includes patient outcomes to investigate whether improved management as a result of our intervention is translated into improved patient outcomes.
Interventions
Emergency departments (EDs) randomised to the intervention arm will receive a targeted, theory and evidence-informed implementation intervention designed to increase the uptake of key evidence-based recommended practices in the management of mild head injured patients.
The intervention will involve local stakeholder meetings, identification of nursing and medical clinical opinion leaders in each site; a train-the-trainer day; materials to increase the visibility of tools; and a non-specific re
Emergency departments (EDs) randomised to the intervention arm will receive a targeted, theory and evidence-informed implementation intervention designed to increase the uptake of key evidence-based recommended practices in the management of mild head injured patients. The intervention will involve local stakeholder meetings, identification of nursing and medical clinical opinion leaders in each site; a train-the-trainer day; materials to increase the visibility of tools; and a non-specific reminder to optimise data collection and standardised education and interactive workshops delivered by the clinical leaders over a 3 month period of time.
Sponsors
National Trauma Research Institute
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Hospitals: 24 hour (private or public) emergency departments will be eligible for inclusion in the trial. Clinician Cohort: Clinicians (both medical and nursing staff member) who have an appointment with the ED and currently engaged in clinical practice will be eligible for inclusion. Patient Cohort: Patient participants will be eligible for inclusion if they are at least 18 years old, present to the ED within 24 hours after the traumatic event with potential acute brain injury and who have a GCS score of 14 or 15 at presentation.
Exclusion criteria
Hospitals will be excluded if they * are either non 24-hour EDs or specialised hospital (e.g. women’s or children) and therefore do not routinely treat adult patients with TBI; * do not have a CT scanner on site; or if there is a significant risk of bias (e.g. risk of contamination due to two EDs having the same ED director or senior influential clinicians working across sites). EDs that participated in the pilot of the intervention will be ineligible for inclusion in the trial. Clinician cohort: Academic staff (not currently engaged in the treatment of patients), students/interns, and -for nurses-, bank or agency nurses will be excluded. Patient cohort: penetrating injuries, non-traumatic traumatic brain injury such as caused by stroke. For the patients who participate in the follow-up (NET-Plus), additional exclusion criteria are: patients not consenting to participate in the follow-up study, and reasons (e.g. non-English speakers) for the patient not being able to answer the questions conducted over the phone
Outcome results
None listed