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Abstract Details

Efficacy of the Implementation of Brain Herniation Codes at a Tertiary Medical Center
Neuro Trauma and Critical Care
P1 - Poster Session 1 (8:00 AM-9:00 AM)
1-005
Brain herniation is a life-threatening event that occurs when compensatory mechanisms are overcome by increasing intracranial pressure. At Thomas Jefferson University Hospital, we implemented a brain herniation code (BHC)  alert in 2019 to help quickly mobilize resources and provide care for these patients. However, healthcare providers (HCP) were not aware of this system and thus underutilized. We aim to study the “time to intervention” and outcomes of BHC patients before and after teaching sessions with HCP. We hypothesize that the implementation of BHC with HCP education at TJUH will improve efficiency of clinical care as well as clinical outcomes.  
To reduce time to imaging and intervention for brain herniation codes through provider education. 
We retrospectively evaluated “time to intervention” for BHC patient charts at TJUH between 2019 to 2021. We then provided educational sessions to HCP with a pre and post lecture evaluation. Statistical analysis was performed using Graphpad Prism v9. Pre and post survey results were compared using paired analysis corrected for multiple comparisons. 
Preliminary data found six BHC patients before education sessions. The average time to  CTH was 39.8 + 6.02 minutes and the average time to administering hyperosmolar therapy was 56.6 + 26.23 minutes. We found a statistically significant difference in pre and post test scores in non-neurology residents (p<0.001, n=20) and Neurology residents (p=0.046, n=12) following our teaching session. Non-neurology providers scored significantly better on 3 questions directed at recognizing impending herniation and 1 question about brain herniation protocol (p<0.05, n=20). Neurology residents scored significantly better on 1 question about protocol (p < 0.05, n = 12) post teaching session. 
We found focused teaching had improved general knowledge and comfort regarding BHC.  We continue to collect post education data to see if there is an improvement in “time to intervention” and patient outcomes. 
Authors/Disclosures
Eunice Jiyoung Lee, MD
PRESENTER
Dr. Lee has nothing to disclose.
Lucy Elizabeth Gee, PhD (Jefferson Neurology) Dr. Gee has nothing to disclose.
Malissa Pynes, MD (Keck Medicine of USC) Dr. Pynes has nothing to disclose.
Courtney Curran, MD (Thomas Jefferson University, Department of Neurology) Dr. Curran has nothing to disclose.
Rebecca T. Hsu, MD (Thomas Jefferson University, Department of Neurology) Dr. Hsu has nothing to disclose.
Julian Gal, MD, MA (Thomas Jefferson University, Department of Neurology) Dr. Gal has nothing to disclose.
Jennifer Hannah Newman, MD (Jefferson Neurology) Dr. Newman has nothing to disclose.
Elizabeth Woods Fletman, DO (Thomas Jefferson University Hospital) Dr. Fletman has nothing to disclose.
Pooja Gupta, MD (Thomas Jefferson University Hospital) Dr. Gupta has nothing to disclose.
Emma Yellin, MD (Jefferson) Dr. Yellin has nothing to disclose.
Alexander Buslov, MD Dr. Buslov has nothing to disclose.
Henry Millard Lee, III, MD (Christiana Care Neurology Specialists) Dr. Lee has nothing to disclose.
Kasun Indika Navarathna, MD (Yale New Haven Hospital) Dr. Navarathna has nothing to disclose.
Matthew Vibbert, MD (Thomas Jefferson University) Dr. Vibbert has nothing to disclose.
Syed Omar Shah, MD Dr. Shah has nothing to disclose.