Date of Award

Spring 5-31-2019

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Karen Macauley, PhD, DNP, FNP-BC, GNP-BC

Second Advisor

Kim Woodruff, MD, MPH


Background: An estimated 3.8 million concussions occur yearly in the United States and the incidence of youth concussions is on the rise. If untreated or unrecognized, more serious complications of concussions include post-concussion syndrome, second impact syndrome, and chronic traumatic encephalopathy. Clinic leadership in a southern California student health center identified systematic inefficiencies and noted a lack of standardized follow-up concussion appointment times which resulted in decreased clinic efficiency.

Purpose: The purpose of this evidenced-base project was to implement an effective concussion protocol and follow-up treatment plan that would improve clinic efficiency without negatively impacting concussion outcomes.

Evidence-based Interventions: A concussion management protocol was implemented utilizing evidence-based interventions to include standardized assessment of concussion, cognitive and physical rest as the mainstay of treatment, as well as staged return-to-learn and return-to-play recommendations. Follow-up appointments utilized telemedicine to improve clinic efficiency.

Results: The number of in-clinic face-to-face follow-up appointments decreased by 70%. Telemedicine follow-up times were on average 15 minutes less than the face-to-face follow-up appointment times improving provider and clinic staff resource utilization. There was not a negative impact on concussion outcomes or post-concussion symptoms.

Implications for Clinical Practice: The implementation of an evidenced-based concussion protocol and telemedicine for visits improved clinic efficiency and increased access to care without having a detrimental effect on post-concussive outcomes.

Included in

Nursing Commons