POAC Winter Funding Initiative (till 30th September 2023)
A short-term winter funding initiative for CT Head scans to be performed in the community following minor head injury is available until the end of September 2023.
Patients with a minor head injury who meet specific referral criteria may be able to have a CT Head in the community, via POAC, as an alternative to sending the patient to ED for assessment. Patients must have been discussed with, and endorsed by, an ED consultant who will also provide a time frame in which the CT needs to be completed.
If POAC is unable to arrange a CT Head in the appropriate time frame for some patients, due to limited CT Head capacity in the community at that time, POAC will contact the referring clinician (GP, UC, NP) immediately and advise them that the CT Head cannot be done. The patient should then be sent directly into ED without further discussion with an ED consultant. An acute admission eReferral will need to be sent.
For further information including the specific referral criteria, see CT Head for Minor head injury – POAC winter funding initiative.
Community CT Head for Minor Head Injury - POAC Winter Funding Initiative
This scheme is available for patients who:
· have had a minor acute head injury; and
· have one or more predictors of risk that mean further assessment is required; and
· you consider a CT Head scan in the community may be appropriate and safe.
HEAD INJURY PREDICTORS OF RISK:
History of head injury plus any one of:
Glasgow Coma Scale < 14 at any time
Glasgow Coma Scale < 15 two hours from injury
Clinical suspicion of skull or facial fracture
Focal neurological deficit
Vomiting > 1 episode
Coagulopathy e.g., warfarin, dabigatran, clopidogrel, or alcoholic
Concerning mechanism of injury:
MVA ejection or roll-over
Pedestrians or cyclists hit by vehicle
Falls from greater than own height or 5 stairs
Falls from horses or bicycles
Focal blunt trauma e.g., bat, ball, club
Prolonged loss of consciousness
Post-traumatic amnesia, with amnesia of events:
> 30 minutes before injury. Retrograde amnesia indicates possible severity of head injury.
> 5 minutes after injury. A short period of anterograde amnesia is common. If the amnesia continues it is predictive of a greater severity of head injury.
Severe headache
Seizure
Aged ≥ 65 years with significant co-morbidities, or any other specific concerns that may prevent them from being managed appropriately in the community
REFERRAL PROCESS:
1. Call your local ED consultant to discuss the patient. The ED consultant may:
advise you to send the patient to ED for assessment (usual process); OR
endorse requesting a POAC-funded CT Head in the community; OR
provide alternative management advice.
2. If a Community CT Head is endorsed, you will need to document the ED consultant’s name and the timeframe they advise for the Head CT (e.g. within 12 hours/24hours/36 hours of your phone call). POAC requires this information to be documented on the request form before a CT Head can be arranged.
3. Advise the patient that you may be able to get them a CT Head scan in the community, but only if there is an appointment available in the recommended time frame. Otherwise, they will need to go to ED for assessment (usual process).
4. Complete a POAC referral via your PMS (in the normal way), to generate a new POAC number. Use diagnosis code "Head CT for ACC Minor Head Injury (till 30 Sept 2023)".
Include the following information on the form:
This is a CT Head request for a minor head injury, under the winter radiology funding initiative
·Date and brief details of the injury, clinical concern, and any other relevant info e.g., the patient is on anticoagulant
ACC number
Name of the ED consultant who has endorsed the CT Head
The timeframe in which the CT Head must be completed
Emergency contact details for yourself, or your practice, if a CT Head cannot be arranged within the appropriate time frame
Patient contact details. Please ensure these are up to date on the radiology request form
5. Call the POAC team at (09) 535 7218 and request a 'CT Head for Minor Head Injury' under the Winter Funding Initiative. Email the radiology form to referral@poac.co.nz
POAC will make all efforts to arrange a CT Head in the required timeframe. When a Community CT Head has been booked, POAC will notify the patient and the referring clinician of the time and location. (See point 7 if unable to secure booking)
6. Referrer follow-up of results
Ensure the CT Head report is reviewed as soon as it is available and take any appropriate clinical actions.
If unsure of the next steps, seek advice from the appropriate secondary care team (e.g., ED, Neurosurgery).
7. If a CT Head cannot be booked within the required time frame POAC will contact the referring clinician. The clinician will then arrange for the patient to be assessed in ED.
Contact the patient and let them know that there were no CT Head appointments available in the community and ask them to go straight into ED for assessment.
No further phone call or discussion with ED is required.
Simply send an acute admission eReferral and include the following information:
All relevant clinical details including the ACC number, name of the initial ED consultant who endorsed a POAC-funded CT Head, and the recommended time frame.
That there are no community CT Head appointments available within the recommended time frame.
Any other relevant information.
Be aware that the Referring Community Clinician will be responsible for:
Safety netting while the patient waits for the CT Head appointment; and
Following up on the CT head results and taking any appropriate clinical actions.