Efficacy of the Implementation of Brain Herniation Codes at a Tertiary Medical Center (P1-7.005)

Abstract

<h3>Objective:</h3> To reduce time to imaging and intervention for brain herniation codes through provider education. <h3>Background:</h3> Brain herniation is a life-threatening event that occurs when compensatory mechanisms are overcome by increasing intracranial pressure. At Thomas Jefferson University Hospital, we implemented a brain herniation code (BHC) alert in 2019 to help quickly mobilize resources and provide care for these patients. However, healthcare providers (HCP) were not aware of this system and thus underutilized. We aim to study the “time to intervention” and outcomes of BHC patients before and after teaching sessions with HCP. We hypothesize that the implementation of BHC with HCP education at TJUH will improve efficiency of clinical care as well as clinical outcomes. <h3>Design/Methods:</h3> We retrospectively evaluated “time to intervention” for BHC patient charts at TJUH between 2019 to 2021. We then provided educational sessions to HCP with a pre and post lecture evaluation. Statistical analysis was performed using Graphpad Prism v9. Pre and post survey results were compared using paired analysis corrected for multiple comparisons. <h3>Results:</h3> Preliminary data found six BHC patients before education sessions. The average time to CTH was 39.8 + 6.02 minutes and the average time to administering hyperosmolar therapy was 56.6 + 26.23 minutes. We found a statistically significant difference in pre and post test scores in non-neurology residents (p&lt;0.001, n=20) and Neurology residents (p=0.046, n=12) following our teaching session. Non-neurology providers scored significantly better on 3 questions directed at recognizing impending herniation and 1 question about brain herniation protocol (p&lt;0.05, n=20). Neurology residents scored significantly better on 1 question about protocol (p &lt; 0.05, n = 12) post teaching session. <h3>Conclusions:</h3> We found focused teaching had improved general knowledge and comfort regarding BHC. We continue to collect post education data to see if there is an improvement in “time to intervention” and patient outcomes. <b>Disclosure:</b> Dr. Lee has nothing to disclose. Dr. Gee has nothing to disclose. Dr. Pynes has nothing to disclose. Dr. Curran has nothing to disclose. Dr. Hsu has nothing to disclose. Dr. Gal has nothing to disclose. Dr. Newman has nothing to disclose. Dr. Fletman has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Yellin has nothing to disclose. Dr. Buslov has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Navarathna has nothing to disclose. Dr. Vibbert has nothing to disclose. Dr. Shah has nothing to disclose.