Table 1 Delivery of the intervention

Intervention and control group

 1. An electronic/printed copy of Initial management of closed head injury in adults guideline [26]. 

 Intervention sites received an electronic copy of the guideline at the Train-the-Trainer workshop. Control group departments received their copy in between the first and second Train-the-Trainer event (July 2014). When control sites asked for guidance on what to do with the guideline, they were instructed to do what they would normally do if they became aware of a guideline relevant to their practices.

 2. Data collection reminder sticker/flag in system and education around the importance of documenting information for mTBI patients to optimise data collection.

Intervention group only

 3. One hour face-to-face multidisciplinary stakeholder meeting in each participating ED with key stakeholders (both clinical and organisational/change management) and senior NET clinicians and researcher to create buy-in at ‘organisational’ level for the changes by discussing the key recommendations and underlying evidence; discussing intervention components and how to overcome anticipated barriers for their implementation.

 4. Identification of multidisciplinary local opinion leader team (medical and nursing) via key-informant method [69] (ED Directors were provided with a description of the types and characteristics of people suited to the role (Additional file 5)

 5. One day train the trainer interactive workshop, led by content experts and senior NET clinicians, attended by the nursing and medical opinion leaders, consisting of information provision and skills training both in relation to the key recommendations as well as in relation to their role in the study

 6. Following the Train-the-Trainer workshop, opinion leaders were asked to provide training to their staff members over a 3 month period of time. Opinion leaders were provided with power-point presentations with standardised text and other training materials such as case descriptions and pre-recorded demonstration sessions.

 7. Provision of relevant tools and materials (e.g. PTA screening tools, CT-head rules [26] and patient information booklets [27] translated into five languages that are commonly spoken in Australia)