Date of Award

Spring 5-5-2018

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Karen Sue Hoyt, PhD, RN, FNP-C, ENP-C, FAANP


The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse practitioners, physician assistants) were trained in the American College of Emergency Physicians’ (ACEP) traumatic brain injury clinical guideline with one-on-one education. Pre-intervention, retrospective, baseline data were collected comprising a period of 4 months (n = 152). Three months of post-intervention data were collected to assess adherence to the guideline (n = 132), including physicians’ charts that were reviewed as a comparison. The findings demonstrated a statistically significant reduction head CT scans that did not meet ACEP criteria (p = .010). The results of this project suggest improved medical-decision making among advanced practice providers, avoidance of unnecessary costs, and a reduction in radiation exposure for patients. This project could be easily replicated in other emergency department settings using the ACEP traumatic brain injury guideline as part of their standardized procedures, clinical policies, or protocols.