Screening for Traumatic Brain Injuries (TBI) in Veterans: A Quality Improvement Project to Change the Identification and Referral Process in Primary Care Providers.

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide information specific to TBI and screening for this condition. Data about rates of diagnoses and referrals for a 4-month period prior to intervention were measured against those during the 4-month pilot period. Effectiveness of educational interventions were measured through post-intervention survey and follow-up focus groups. Results: Retrospective data indicated that 319 veterans presented for care during the 4 months prior to the initiation of the proposed change in process. Of this number, 10 screenings were performed by the provider/staff, resulting in 2 referrals for follow up. Out of the 100 veterans who presented to the CBOC during the implementation phase, 13 screenings were performed by the DNP student, 5 of which were positive. The change in process resulted in an increase in TBI screenings being performed on veterans presenting for care in the CBOC by 10%, which can be attributed to one or more of changes in process that occurred due to this project. Results from pre-intervention and post-intervention surveys indicate an increase in knowledge base on TBI symptoms and screening process. Conclusion: The screening process for identifying traumatic brain injuries in veterans is improved by increasing the knowledge about identifying TBI among healthcare providers, increasing the frequency of evaluation in veterans, and broadening the scope of which veterans are screened. Creating more effective TBI screening procedures in primary care settings and using a well-defined and specific tool will increase rates of identification, leading to appropriate referrals, treatment, and improved health outcomes in veterans. Due to the Department of Veterans Affairs being a federally governed institution, the changes implemented during this project would require approval prior to being considered as a sustainable intervention throughout the entire organization