Gunnison Valley Health Advances Trauma Care with Modified Brain Injury Guidelines (mBIG)

Gunnison Valley Health (GVH) is advancing rural trauma care with the implementation of the Modified Brain Injury Guidelines (mBIG). Introduced in 2023 and refined in 2024, mBIG has enabled GVH to provide more precise, effective care for patients with mild traumatic brain injuries (TBI), ensuring patient safety while minimizing costs and stress for patients and their families. GVH became the first hospital in the Western Colorado region to adopt the mBig guidelines, joining a select group of hospitals in the Southern region of the state.

The Journey to mBig Implementation
The need for a different, more structured procedure for patients with mild traumatic brain injuries became evident during the COVID-19 pandemic, when the GVH hospital struggled to find available beds for patients. Neurosurgeons in larger trauma centers were recommending that GVH keep certain patients in the emergency department (ED) overnight and discharge them the next day after a repeat scan. This change in typical protocol laid the foundation for the implementation of the mBig guidelines at GVH.

In 2023, the GVH trauma team, in collaboration with a physician experienced in the mBig guidelines, conducted an extensive literature review and developed a formal policy to integrate these guidelines into patient care practices at GVH. ED physician and former ED Medical Director, Dr. Gary Witt, worked closely with the GVH radiology team, physicians and other healthcare facilities to ensure that with their support and guidance we could safely keep these patients in our community.

Introduction and training was then provided to the clinical teams and medical staff at GVH before officially launching in July of 2023. Throughout early 2024, the process was further refined based on patient outcomes and clinical feedback. By August of 2024, GVH had gained regional recognition for its successful implementation and were receiving requests to share its policy and procedures from other facilities on the Western Slope who were also interested in implementing the guidelines.

Smarter, Safer Care Through mBIG
The mBIG guidelines employ a tiered system to classify brain injuries based on severity, guiding clinicians in tailoring treatment plans for each patient. The categories—mBIG 1 for the least severe cases, mBIG 2 for moderate injuries and mBIG 3 for the most severe—create a clear roadmap for treatment decisions, spanning observation, monitoring and advanced interventions.

GVH’s journey with mBig began in 2023, and the results were immediate. Of the nine mBig 1 cases, two required brief observation in the emergency department, four were cared for on the medical-surgical floor and three patients with additional complications were transferred to a higher level of care. None of the discharged patients categorized as mBig 1 returned to GVH with head bleed-related complications, demonstrating the framework’s ability to avoid unnecessary hospital stays or transfers.

Expanding Impact in 2024
Building on its early success, GVH expanded the use of mBIG guidelines in 2024, refining its processes to further improve outcomes. The hospital safely avoided 12 unnecessary transfers to larger trauma centers. These 12 patients were able to be discharged from the emergency department after being observed or admitted to GVH for other medical or traumatic reasons. As in 2023, no discharged patients categorized as mBIG 1 experienced head bleed-related complications, reaffirming the guidelines’ safety and effectiveness at GVH.

“mBIG has transformed how we care for patients with traumatic brain injuries at Gunnison Valley Health,” said Dr. Stephanie Porter, Chief Medical Officer at GVH. “By allowing us to safely manage more TBI patients locally, we’re preventing unnecessary transfers to larger trauma centers, reducing costs and easing the emotional burden on loved ones and caregivers. At the same time, mBIG ensures we deliver the highest standards of care for patients with TBI.”

Patient-Centered Trauma Care in the Gunnison Valley
The impact of the mBig protocol extends beyond the hospital walls, improving the entire patient experience while strengthening the region’s healthcare system. By keeping more patients safely in the Gunnison Valley, GVH has helped reduce the burden on families who would otherwise face the financial and emotional strain of long-distance transfers. At the same time, the guidelines have played a crucial role in preserving limited emergency resources, reducing the need for costly ground and air transfers to larger trauma centers. But most importantly, this approach has reinforced GVH’s commitment to patient-centered care, giving individuals access to high quality treatment while remaining in the Gunnison Valley, close to families and their support systems.

“Implementing mBIG wasn’t just about adopting new guidelines—it was about creating a system that works for our community,” said Jason Amrich, CEO of GVH. “These guidelines are helping us provide better care, save resources, and most importantly, keep our patients safe.”

As GVH continues its work with mBIG, the hospital is setting a new standard for trauma care in rural settings. The results from 2023 and 2024 highlight the power of innovation and the dedication of GVH’s healthcare team to its community.