Abstract Aim Head Injury is a common presentation in our DGH, which covers a large rural area and is now a regional trauma centre. We audited our management of head injuries against current guidelines and planned a new pathway to ensure patients receive the correct advice and follow up on discharge. Method Data was requested from IT for all head injury episodes in 2019, to reflect usual numbers pre-pandemic. Electronic letters, radiology and notes were used to identify whether imaging criteria was met/carried out, discharge destinations, re-presentations, specialty discussions, and head injury advice on discharge. Results 307 individual patients identified. 13 re-presentations. 10 required neurosurgical discussions. Destinations 226 (73.6%) discharged direct from ED. Admissions; Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did not wait – 2 (0.7%), Not Recorded – 7 (2.3%). Imaging 100 patients met NICE criteria for CT, 100% were documented in notes and had CT. 76% reported normal, 18% had a bleed, contusion or haematoma. HI advice 90% of ED discharges, 16% of Surgical and 16% of Medical discharges had head injury discharge advice documented. Conclusions Guidelines were met for 100% of patients requiring imaging Head injury advice was well documented in ED but fell down in ward paperwork. We have written a robust pathway where all inpatients have a proforma completed during admission with prompts for discharge advice and rehab referral where appropriate, this is currently undergoing a re-audit to ensure improvement and if successful will become an established part of the trauma pathway in our hospital.