Quality Improvement Project to improve the quality of CT head requests for acute confusion and reductions in GCS

Introduction
Computed tomography (CT) of the brain plays a crucial role in identifying pathologies responsible for acute confusion and reductions in Glasgow Coma Score (GCS). The quality of radiological request forms is essential to both radiographers and radiologists, with inadequate detail leading to avoidable delays and a reduction in diagnostic accuracy.  This Quality Improvement Project (QIP) aims to improve the quality of CT brain requests submitted to investigate acute confusion and reduced GCS between December 2025 and February 2026, from the Care of the Elderly (COTE) wards and the Medical Admissions Unit (MAU).

Method
Baseline data was collected by assessing the quality of CT brain requests using a standardised 0–8 point scoring system. The following 4 domains are scored on a 0-2 point scale, depending on the level of detail within the request: current status of patient, patient background, history/examination findings and intended management plan.  Requests from the COTE wards and MAU during December 2025 were included. A Plan–Do–Study–Act (PDSA) cycle was then implemented to drive improvement. The intervention consisted of a targeted teaching session and educational posters outlining the essential clinical information required for CT brain requests.

Results
A total of 86 CT brain requests were assessed for December 2025, with a mean quality score of 3.01. Following implementation of the interventions, repeat data collection was conducted in February 2026 using the same scoring methodology.  This yielded a mean quality score of 3.35, across 78 CT brain requests (p-value = 0.036).

Conclusion
The QIP achieved a modest, but significant, improvement in CT brain request quality; demonstrating the impact of educational interventions.  However, reinforcement and additional PDSA cycles are required to achieve further improvement.