PP16 Coming to a head: auditing clinician adherence to updated English head injury guidance in remote telephone assessment of ambulance service cases

<h3>Background</h3> Following the release of NICE guideline NG232, an opportunity arose to evaluate uptake of the recommendations on head injury management within an NHS ambulance service, with reference to increased risk of intracranial haemorrhage in patients taking antiplatelets. Little is currently known about the appropriateness of decisions made through remote clinical assessment in ambulance service environments. <h3>Methods</h3> We conducted a retrospective audit of telephone assessments performed by ambulance service clinicians. Computerised records were retrieved for the month of May 2023, and subsequently for May 2024. Cases were included if categorised at the time of initial call under ‘Trauma’ or ‘Fall Injuries Unknown’ conditions, and if examination of the notes by a trainee ACP revealed suspicion of head injury. The triage system used by call assessors documents anticoagulant usage, and free-text note searching enabled identification of cases where antiplatelets had been documented. Aspirin monotherapy was excluded; we did not identify any patients taking ticagrelor or other antiplatelets. The outcome measure investigated was referral for hospital management, either by ambulance dispatch or by patients’ own transport. <h3>Results</h3> In May 2023, of patients taking clopidogrel assessed for head injury, 13/20 (65%) were referred for hospital management, compared to 18/18 (100%) of those taking anticoagulants. Following further team education embedding the updated guidance, we re-evaluated adherence. In May 2024, of patients taking clopidogrel, 22/24 (92%, OR=5.9) were referred for hospital management, compared to 16/16 (100%) of those taking anticoagulants. <h3>Conclusions</h3> Variance between the updated guidelines and actual clinical practice was identified, with lack of awareness of the updated guidelines suggested as the most probable cause for the insufficient referral rate. Re-audit following further education was encouraging, and this method of audit appears to be effective in the context; we therefore anticipate further work exploring other aspects of quality assurance in services of this type.