Abstract
Introduction:
Intracerebral haemorrhage (ICH) accounts for 10-20% of strokes worldwide. Mortality is high at 40% and survivors might suffer from severe disabilities that massively impact quality of life and independence. Diagnosis and treatment are straight forward. A non-contrast CT head scan is diagnostic. Treatment is focused on prompt anticoagulation reversal and blood pressure control, with consideration of surgery in appropriate cases and admission to an acute stroke unit or an intensive care unit.
Methods:
Two PDSA cycles of 28 and 29 patients were completed in the acute stroke Unit between 2020-2022 (8 months apart), Data gathered included blood pressure readings on admission and intervention to control it. The percentage of anticoagulation reversal was noted. We recorded if each patient was admitted to the stroke unit and if the patient was discussed with neurosurgery. Interventions post-first PDSA cycle included implementing a formal bundle of care, reflecting ABC-ICH practice, formalisation of the departmental guideline on blood pressure control, anticoagulation reversal and neurosurgical referrals. Teaching sessions were delivered to junior doctors and stroke assessor nurses.
Results:
Anticoagulation was reversed in 30% patients on anticoagulant (1% improvement). BP medication was given in 62% compared to 52% yet control within 1 hour was achieved in only 12.5 %. All patients were admitted to ASU (97 % previously). There was an evident improvement in decreasing over-referral to the neurosurgeons, 50% compared to 76% previously, and also in terms of selecting the proper patient to refer where 100% of hydrocephalus patient was referred.
Conclusion:
Although the re-audit has shown consistency in admitting all patients to HASU and decreased numbers of referrals to neurosurgery, it showed an unacceptable shortage in the key management of intracerebral haemorrhage, specifically in two major areas, reversal of anti-coagulation treatment and prompt blood pressure management. Further quality improvement work is being undertaken.