Optimization of Resource Allocation after Implementation of Mild Traumatic Brain Injury Treatment Protocol

Abstract

The purpose of this study was to assess resource utilization after implementation of a mild traumatic brain injury (TBI) treatment protocol. A retrospective review was conducted of patients with isolated mild TBI before and after implementation of a mild TBI treatment protocol in May 2015. Patients admitted from June 2014 to February 2017, aged 18 to 89 years, presenting with a Glasgow coma score of 13 to 15, with an isolated small intracerebral hemorrhage on CT without midline shift, and not coagulopathic were evaluated. According to the protocol, patients were admitted to a non-intensive care unit (ICU) ward, without routine neurosurgical consultation or repeat head CT unless clinically indicated. Hospital length of stay (LOS), ICU LOS, rate of neurosurgical consultation, rate of repeat head CT within 24 hours of admission, and associated costs were evaluated. Forty-six patients were identified in the preprotocol group and 97 in the protocol group. The protocol group had a shorter hospital LOS (1.46 vs 2.04 days, P = 0.0034), shorter ICU LOS (0.02 vs 0.37 days, P < 0.0001), lower rates of repeat head CT (2.06% vs 39.13%, P < 0.0001), and neurosurgical consultations (1.03% vs 28.26%, P < 0.0001). Decreased charges derived from fewer repeat head CT and neurosurgical consultations were observed from $43.98 to $844.04 per patient. There were no inpatient mortalities and no progressions of injury requiring unplanned admission to the ICU or operative intervention. Efficient delivery of care is paramount in modern medicine and this study demonstrates that the mild TBI treatment protocol significantly decreased resource utilization without jeopardizing patient safety.