Objective:

To create a standardized timeout procedure that improves timely treatment and functional outcomes in patients with intracerebral hemorrhage (ICH).

Background:

ICH leads to the highest mortality among stroke patients. ICH expansion causes worse outcomes, especially with anticoagulant-associated ICH. Rapid management of ICH has been shown to improve patient mortality.

Design/Methods:

A checklist was created to be filled out by the nurse, pharmacist, and neurology resident during a timeout procedure for patients with ICH presenting to the emergency department at a large academic medical center. The checklist tracks blood pressure (BP) management and calling neurosurgery. Additionally, the checklist includes verification of antiplatelet and/or anticoagulant (AP/AC) usage with subsequent guidance regarding reversal, including agent used, dose used, and time administered. Training sessions on this process were required for staff members to complete prior to implementation. Data analysis involves comparing initiation times of steps on the checklist as well as difference in admission and discharge National Institutes of Health Stroke Scale (NIHSS) score pre- and post-intervention.

Results:

Data prior to intervention was compiled from January 2021 up to workflow implementation on August 12th, 2024. Post-intervention data is being collected from implementation date onwards. Data analysis thus far has demonstrated significant improvements in patient management. Average time to BP medication initiation improved from 188 minutes pre- to 55 minutes post-intervention. Average time to AP/AC reversal improved from 238 minutes pre- to 50 minutes post-intervention. Time to neurosurgical intervention did not show improvement post intervention. In terms of functional outcome, the average improvement in discharge NIHSS score increased by 1.33 points post-intervention.

Conclusions:

This study demonstrates that a standardized timeout procedure for ICH can increase efficiency in patient management. Reducing delays to treatment has been shown to improve morbidity and mortality associated with ICH, and while data collection is still ongoing, this study already shows improvement in patient outcome.