Background/Aim: General Surgeons are often left to manage patients with ‘moderate TBI’, who require admission to hospital for monitoring, but do not require transfer to Neurosurgery. The Brain Injury Guidelines (BIG) have recently been proposed to guide admission criteria, repeat CT scanning and consultation with Neurosurgery; but fail to provide guidance for concussion management. Our aim was to develop a document to provide best practice guidelines for General Surgeons caring for this cohort of patients and to assess if its use improved outcomes. Method: A guideline was developed in collaboration with Occupational Therapists and the local HOD Neurosurgery. We conducted a single-centre prospective before-after cohort study to evaluate the use of this guideline, in the Department of General Surgery at Middlemore Hospital – a tertiary level public hospital without a Neurosurgical service, in Auckland, Aotearoa NZ. Results: We developed a 17-point scoring system to compare the before-after cohorts. We found improved concussion screening tool use; improved rates of optimal nursing environment; improved documentation of neurosurgical consultations; improved prescribing practices; and more repeat CTs performed in the recommended timeframe. Conclusion: With the use of our guideline, there was improvement in the care provided to patients admitted to General Surgery at Middlemore Hospital with TBI. Our future work will aim to combine aspects of this multidisciplinary approach with the proposed BIG guidelines.