994 Enhancing Compliance with BOAST Guidelines: A Closed-Loop Audit on Cervical Clearance in Head Injury Patients

Aim This audit aimed to evaluate the compliance of cervical spine clearance in head injury patients according to BOAST guidelines following the implementation of a novel intervention, a single request tab, suggested after the previous audits. Method BOAST guidelines state that if brain CT is necessary for a head injury, this should include the CT cervical spine. Previous audits (June/Nov 2021 and Aug/Sept 2022) highlighted a persistent lack of adequate cervical spine clearance in head injury patients at Queen Alexandra Hospital. In response, a solution was proposed and implemented on May 5, 2023, introducing a single request tab within the Imaging requesting software (ICE) for CT Brain and CT C-spine. Data collected from July/Aug 2023 assessed the adherence to BOAST guidelines for all admitted head injury patients. Results The data encompassed 36 head injury patients, primarily diagnosed with subdural hematoma (55%), followed by skull fractures (14%). The audits in 2021 and 2022 revealed suboptimal compliance (23% and 37% respectively) despite interventions. The new implementation showcased a significant improvement, with a 53% compliance rate. This contrasts with the previous audits, suggesting enhanced adherence to BOAST guidelines. Conclusions Ensuring cervical spine clearance in head injury patients aligns with BOAST guidelines, emphasizing patient safety. Our audit demonstrated substantial progress in compliance, signifying improved adherence to guidelines and elevated patient care standards. The implementation of the single request tab streamlined the workflow, enhancing efficiency for clinicians to request scans promptly. We recommend widespread education initiatives for Emergency Department staff and the adoption of the single request tab across all trusts to optimize patient care.