Implementation Outcomes of a Fast-Track Nursing Management Model for Patients with Traumatic Brain Injury with Increased Intracranial Pressure

Abstract

This retrospective study aimed to evaluate the implementation outcomes of a fast-track nursing management model for patients with traumatic brain injury (TBI) and increased intracranial pressure (IICP) at a tertiary hospital. The model was developed based on the Donabedian quality of care framework, which includes structure, process, and outcomes. The model was implemented in 2018 and revised until integrated in routine work. Data were collected from the “Neurobyte” database for the fiscal years 2021-2023. Descriptive statistics were used for data analysis. Results showed that the number of patients with severe TBI were 113, 123, and 164, respectively. They were middle-aged adults. One-third of the patients underwent brain surgery. Outcomes evaluated in each aspect were as follows: For structure, neurosurgical nurses demonstrated knowledge of the care of patients with IICP higher than the predetermined criterion (> 70%). For process, although the mean of emergency department waiting time before admission to the ward was more than 100 minutes was longer than the standard (< 60 min), the mean preoperative time for urgent surgery (both order to operating room and order to time-in operation) was less than the standard (< 30 minutes and < 60 minutes, respectively). For patient outcomes, the mortality rates declined from 41.6% to 31.7%. The percentage of patients with good recovery at discharge increased from 40.7 to 48.2. The median length of hospital stay was 6-7 days. The study findings specified the following issues for further improvement: evaluation of care outcomes should commence at the emergency room, and quality improvement should be focused continuously.