Protocol in Practice: Impact of Brain Herniation Code Alerts at a Tertiary Level Medical Center.

Introduction: Brain herniation is a life-threatening condition due to increased intracranial pressure. Timely intervention is essential to improving outcomes. Brain herniation code alerts (BHCA) were instated at our institution to streamline management. We launched a quality initiative to increase protocol utilization and reduce intervention time.

Methods: Educational sessions were held for house staff (e.g., surgery, medicine, neurology residents, advanced practice providers) with pre-educational and post-educational surveys. BHCA were reviewed retrospectively: 38 pre-education and 15 post-education. We measured time to head computed tomography (CTH), hyperosmolar therapy, Glasgow Coma Scale (GCS), and in-hospital mortality.

Results: House staff assessments improved after educational sessions (p < .001). They correctly activated BHCA in 100% of post-education cases (vs. 18.4% pre-education). Time to CTH was similar (pre: 35.7 ± 6.42 minutes; post: 41.9 ± 6.36 minutes). Time to hyperosmolar therapy trended toward faster administration (pre: 20.5 ± 2.5 minutes; post: 13.67 ± 2.03 minutes, p = .05). No significant differences were found in GCS or mortality (p > .05).

Conclusions: Providers had better understanding of BHCA due to education sessions, increasing BHCAs called and improving time to medication administration.

Implications for practice: Brain herniation syndromes are rare but have high mortality if not treated immediately. A streamlined process is critical for rapid diagnosis, resource mobilization, and timely intervention. Ongoing system improvements and staff education can reduce errors and improve outcomes.