Introduction: Our center launched the "ICH Phases'' communication system to accelerate ICH patient care. Patient outcomes are improved with the application of ultra-early bundled interventions including blood pressure management, coagulopathy reversal, and osmotic therapy. We describe a 3-tiered paging system at our comprehensive stroke center that allows rapid and efficient mobilization of resources and care teams to deliver ultra-early intervention for ICH patients.
Methods: A multidisciplinary team was created and paging system was designed to ensure immediate response of the teams. The system was further classified into phases I and II. If the patient has an ICH score greater than 1, a systolic blood pressure greater than 160 or is on anticoagulation then a phase 2 is called to mobilize the neuroscience intensive care unit team and neurosurgery and expedite both early targeted medical and surgical interventions. These interventions include blood pressure control using clevidipine, reversal of anticoagulation and evaluation for external ventricular drain, minimally invasive surgery, hematoma evacuation or decompressive hemicraniectomy.
Results: The reviewed ICH (Intracerebral Hemorrhage) metrics demonstrated strong performance in most areas, with four out of five targets met or exceeded. The average door to CT scan time was 17 minutes, well within the target of 25 minutes. Blood pressure management metrics also showed favorable outcomes, with the first dose of antihypertensive medication administered within an average of 30 minutes (target: 60 minutes) and blood pressure goals achieved within 75 minutes on average (target: 120 minutes). Additionally, the door to initiation of anticoagulation reversal was 70 minutes, outperforming the 120-minute target. The only area falling short of the established benchmark was the documentation of the ICH Score, which was completed in 82.9% of cases, below the target of 90%.
Conclusions: ICH systems of care need to be considered from a holistic approach towards optimized communication and resource mobilization. The initial minutes to hours are crucial determinants of patient outcomes. Hence, adopting a holistic 3-tiered paging system delivers ultra-early interventions for this population.
