It's Not 'Just a Headache"Quality Improvement Project on 'Headaches in Children'

ABSTRACT

Objectives: To improve the efficiency of management of headaches in children presenting to Children's Assessment Unit (CAU) in a District General Hospital (DGH). To implement strategies to improve the quality of care and ensure patient safety. Method(s) Retrospective data were collected for 6 months (from September 2020 to February 2021). Documentation, diagnosis, and management plans were audited. This was compared against NICE guidelines on headaches in children and young people. Result(s) We had 23 children from 6 to 16 years. Documentation was 92% compliant in elaborating symptoms and 100% in eliciting red flags and neurological examination. Major diagnoses were migraine, tension, and cluster headaches. We had 3 (13%) children with Benign Intracranial Hypertension who were referred to tertiary hospital. We identified the following areas for improvement Unclear management plans where the type of headache is a dilemma in the first presentation. Lack of written information given to parents. Difficulty in referral to the urgent eye clinic for fundoscopic examination. The following changes were implemented Trust guidelines were revised giving easy access to the registrars by including a flow chart that covered headaches of diagnostic dilemmas and follow-up plan. We created an eco-friendly COVID-19 safe QR-coded parent information sheet for headaches in children with a symptom diary as an annexure. We involved the ophthalmology department and a referral form for an urgent eye clinic was created to facilitate easier communication between the departments. Conclusion(s) In summary, good quality of care was met in terms of diagnosis and documentation but needed improvement in management. The lack of pathways and access were identified as the major cause for this. Following the implementation of the above changes, the audit will be repeated.