Abstract Body: Background and Issues: Timely identification and intervention are critical for positive outcomes in acute intracerebral hemorrhage (ICH) patients. The 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association states that we should control blood pressure, reverse anticoagulation, and get the patient to a specialized inpatient stroke unit. Unlike multiple clearly defined target goals for ischemic stroke, there are no established measurable goals for ICH. The absence of specific target times for ICH leads to delays in identification and treatment, resulting in poor outcomes.
Purpose: This project aimed to rapidly identify and aggressively manage ICH patients with clearly defined treatment times to reduce mortality and 30 day readmissions.
Methods: The implementation of measurable goals for ICH in the Emergency Department (ED) was an approach to improve ICH patient outcomes by facilitating faster identification and treatment. The stroke team reviewed existing performance data and outcomes to determine reasonable times for completing the following interventions: Cat Scan imaging within 30 minutes of being ordered, blood pressure medications given within 30 minutes of diagnosis, reversing anticoagulation within 45 minutes of diagnosis, and moving patients to the Neuro ICU within 90 minutes of diagnosis. The ED team was educated on the new performance goals. The stroke team collected, analyzed, and reported the performance metrics of the ED team throughout implementation. Outcomes were measured using data for when the goals were being met versus not being met.
Results: Outcomes were measured from 111 ICH patients from 2022-2023. When treatment time goals were not met, the mortality rate for ICH patients was 18.42% with an observed/expected (O/E) ratio of 1.25. The 30 day readmission rate was 12.9%. When treatment goals were met, the mortality rate decreased to 12.68% with an O/E ratio of 0.86. 30 day readmission rate dropped to 3.23%
Conclusions: Having measurable goals for ICH has demonstrated a significant improvement in outcomes. Establishing clear time targets for getting imaging, initiating blood pressure control, reversing anticoagulation, and admission to Neuro ICU led to a reduction in mortality and 30 day readmissions. It is recommended to use clearly defined time goals to ensure prompt intervention and improved prognosis for patients with ICH.