Supporting Residents After a Head Injury – A New Approach

A New Approach to Supporting Residents After a Head Injury

Introducing the Pragmatic Community Head Injury Pathway

If you work in a care home, you will know how often falls happen - and how worrying it can be when a resident hits their head.

Until now, many of these incidents have resulted in a transfer to the Emergency Department. While this is done with safety in mind, it can also be distressing for residents and disruptive for staff, often involving long waits and time away from familiar surroundings.

The pragmatic community head injury pathway has been developed to support a different approach—helping more residents to be cared for safely in their own care home.

What is changing for care homes?

The key difference is that not every head injury will automatically require a hospital visit.

Instead, where it is safe to do so, residents may:

Remain in the care home
Be monitored by staff with clear clinical guidance
Be reviewed remotely or in person by NHS teams
Access a planned CT head scan if needed, without going through the Emergency Department

This means fewer unnecessary hospital transfers, while still ensuring residents receive the right care.

Why this matters for your residents

For many residents living with frailty, a trip to hospital can lead to:

Confusion or delirium
Reduced mobility
Loss of confidence
Longer recovery times

By supporting care in the home environment, this pathway aims to:

Reduce distress for residents
Maintain routine and familiarity
Avoid unnecessary admissions
Still ensure safe clinical decision-making

What this means for your role as a care home

This pathway recognises the expertise and central role of care home staff.

In addition to usual care, you will also have:

Clearer guidance on what to do after a head injury
Direct access to clinical advice via the Single Point of Access (SPOA)
Support from NHS services, including Acute Hospital at Home and Urgent Community Response teams

For residents without concerning symptoms, monitoring in the care home will often be appropriate, with escalation if anything changes.

Safety remains the priority

It’s important to stress that this is not about reducing safety or support.

Residents showing any concerning symptoms - such as changes in consciousness, neurological symptoms, or significant injury - will still require urgent escalation to emergency services.

The pathway simply helps identify when care can safely remain closer to home.

Working with you to make this work

We know that for any pathway to be successful, it has to work in real-world practice—and that means it must work for care homes.

We are keen to:

Work closely with care home teams
Listen to your experiences and feedback
Understand what support you need
Adapt the pathway so it is practical, clear, and manageable within your setting

Your input will be essential in shaping how this pathway develops.

Learning from elsewhere

A similar pathway has already been successfully implemented in Plymouth, showing that it is possible to safely manage many head injuries without a hospital transfer.

We are now looking to introduce this approach across the Royal Devon University Healthcare NHS Foundation Trust area, working alongside care homes to ensure it meets local needs.

In summary

For care homes, this pathway aims to:

Reduce unnecessary hospital transfers
Support safer care within the home
Provide clearer guidance and stronger clinical support
Improve resident experience after a fall

Most importantly, it supports a shared goal: providing the right care, in the right place, at the right time for your residents.

We hope to come and discuss this pathway with you at a future managers’ meeting. In the meantime, if you have any questions, please contact heather.wolhuter@nhs.net for further information.

Posted by Michaela on June 22nd 2026