Standardizing Concussion Management Across Seven Youth Correctional Facilities in Utah: A Quality Improvement Project

Background: A quality improvement project was conducted over a three-month period aimed at improving concussion management across seven youth correctional facilities in Utah. Concussions are a growing public health concern and are seen in the highest numbers among incarcerated young men ages 15-24. Untreated concussions can lead to future cognitive deficits and exacerbate mental health disorders, which are also seen in higher numbers in justice-involved individuals. Concussion screening and use of evidence-based guidelines are important components of concussion management that not only improve workflow and staff communication, but more importantly, neurologic health for the impacted youth. Local Problem: Seven health care clinics housed in youth correctional and secure housing facilities in Utah lacked a standardized way of managing concussions. Without standard care delivery in this population has led to inconsistent and unpredictable outcomes. The purpose of this quality improvement project was to implement a concussion toolkit across the clinics within these youth correctional facilities in order to improve medical staff workflow, concussion management, and patient outcomes. Methods: A needs assessment survey assessed medical staff workflow, barriers, and facilitators to evidence based concussion management. Based on a review of the literature and survey results a concussion toolkit was created. A physical concussion binder with a validated screening tool, care plan, treatment algorithm, Centers for Disease Control guideline and education for staff was provided at each location. A post-intervention survey was sent to staff one month after implementation at a staff meeting. Informal data was collected from staff. Chart audits obtained data on eight managed concussions. Descriptive statistics were used to interpret the results. Results: Eight suspected concussions were assessed one-month post-intervention and 75 percent of concussions (n=6) were assessed using the Acute Concussion Evaluation (ACE) screener. Of those who used the ACE screening tool (n=5), 60% (n=3) said it increased their perceived assessment efficiency. Four providers diagnosed six concussions using the toolkit. Of the four providers who used the concussion toolkit, all of them (100%) said it improved their management of the concussion. The data revealed that no medical staff utilized the ACE care plan for "return to play/school" dates Conclusions: The concussion toolkit was well-received and showed improved efficiency among nurses' assessments. The concussion toolkit also showed improved perceived diagnostic efficiency among providers. An Electronic Health Record (EHR) was implemented during the project which may render the physical binders obsolete but will create immediate interoperability between clinics and allow the toolkit to be integrated into the EHR for future use. The new EHR throughout the Juvenile Justice System makes way for future quality improvement projects because data can be obtained and measured much easier.