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Protocol, Quality improvement, Traumatic brain injury



  1. Gorman, Kimberly M. DNP, RN, AG-ACNP-BC, CNL, CCRN, CNRN, TCRN
  2. Drahnak, Dawn DNP, RN, CCNS, CCRN
  3. Dumire, Russell D. MD, FACS
  4. Noon, Jodi RN, CCRN
  5. Nahouraii, Richard MD, FACS
  6. Morrissey, Shawna DO, FACS
  7. Kieta, Cheryl BSN, RN, CCRN
  8. Guttendorf, Jane DNP, RN, CRNP, ACNP-BC, CCRN


Traumatic brain injury (TBI) remains a major cause of death and disability each year in the United States. Implementation of preestablished evidence-based guidelines has been associated with a decrease in overall TBI mortality and disability.


Objectives: An electronic clinical monitoring tool was developed for monitoring compliance with evidence-based TBI treatment protocols to improve the overall care and outcomes in this patient population.


Methods: This project was designed as a process improvement project. For the preimplementation cohort of TBI patients, aggregate compliance data (by patient) were obtained from the Brain Trauma Foundation Trial patient registry maintained at Conemaugh Memorial Medical Center for the time between 2011 and 2012. The postimplementation cohort includes all patients older than 18 years who have sustained a TBI requiring clinical monitoring devices.


Results: There was a statistical significance between groups; the TBI-2017 group demonstrated better compliance with anticonvulsant use and cerebral perfusion pressure maintenance. In addition, overall compliance was better in the TBI-2017 cohort compared with the TBI-2012 cohort.


Conclusions: Traumatic brain injury-specific education and frequent assessments improved compliance between TBI-2012 and TBI-2017, resulting in a higher percentage in overall survivors in the latter group.