Design and Implementation of a Concussion Protocol in a Rural Healthcare Setting: A Quality Improvement Project

Abstract

Purpose: The purpose of this project is to implement a standardized concussion training and protocol for providers at a rural primary care clinic affiliated with a critical access hospital who care for young athletes who suffer a potential concussion. Learning Objective: Identify a concussion and appropriate Return to Play steps using the Acute Concussion Evaluation (ACE). Strength of Evidence: Annually, an estimated 1.7 to 3 million recreational or sports-related concussions occur with half believed to be either not reported or not detected. Concussions can have lifelong effects including cognitive impairments and mental health problems such as anxiety and depression; therefore, the Centers for Disease Control (CDC) developed the HEADS UP training which incorporates the 6-Step Return to Play Progression Tool and the Acute Concussion Evaluation (ACE) tool to guide providers in diagnosing concussions in clinical settings. Implementation of standardized methods are needed to facilitate safe return to daily routines while avoiding deleterious outcomes of mis- or undiagnosed brain injury. The rural clinic and critical access hospital currently lacks standardized provider training and methods to evaluate these injuries. The ACE tool and the 6-Step Return to Play Progression Tool were not currently being used by this clinic and its providers. Implemented Practice Change: The implemented practice change is using the HEADS UP tool to train providers on concussions and the need for the slow and systematic Return to Play for young athletes with the use of the Acute Concussion Evaluation. Evaluation Methods: The outcome of this project is standardization of care of concussion with use of the HEADS UP concussion tools by educating providers on use of the ACE and ACE Care Plan in the primary care clinic. Results: Results: The Williston Concussion protocol was implemented and 8 of 15 providers took the HEADS UP training. Seven concussions were identified in the clinic and all patients were evaluated using the ACE. Following the initial appointment, the ACE was not used to subsequent screening for concussions in the primary care setting. Following the implementation of the ACE providers did report feeling more comfortable treating concussion in the primary care setting.