The Royal London and Queen's Romford Neurosurgery Society

Time Critical Neurosurgery

Thursday 19th April
Mr Moumin Mohammed presents a case series of Code Black patients treated at The Royal London Hospital

When a significant trauma occurs, every minute is vital for the patient. As one of London’s four Major Trauma Centre and the home to London’s Air Ambulance, we receive patients with severe TBI on a daily basis from wide area in and around London. Alongside advances in pre-hospital care meaning patients are arriving to hospitals sooner after injury and in better condition, at the Royal London Hospital, we developed a protocol to minimize the time from arrival in the emergency department and to commencement of emergency life saving surgery. This protocol was named Code Black. 

Our Code Black protocol has now become established over the last 3 years.  In an audit of the impelementation of the protocol, the vast majority of patients underwent craniotomy or craniectomy for acute subdural haematoma. Compared to our historical control data, code black has reduced the waiting time for getting the essential CT imaging, making a decision and transferring the patient for emergency surgery. This was reflected on patients spending on average four and a half days less in intensive care and has contributed in overall reduction in length of stay.  general. Another frank effect code black introduced was on the quality and effectiveness of the communication between A&E team, trauma team, theatre and neurosurgical team.  

Unfortunately, during the few years before Code Black the documentation of the patients’ specific functional outcomes were inconsistent. So an objective measurement of the effect on outcome couldn’t be achieved.  In the future, we need to improve the quality of our data collection process including short term and long term outcome data.


Audit presentation by Mr Moumin Mohammed. SpR


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