2025 American Academy of Neurology Abstract Website

Objective:

We measured the effect of a standard patient-case specific code ICH feedback form on the use of existing code ICH protocols, including adherence to a standard ICH order set. Caregiver feedback included treatment time metrics for: anticoagulation reversal, order set use, and blood pressure target.

Background:

Our large health system implemented an ED specific protocol for Code ICH management in March 2022. Formalized code ICH feedback began at our comprehensive stroke center in March 2024. Ambitious time to treatment goals were set, such as targeting a door-to-needle goal for anticoagulant reversal of 30 minutes or less. We expect regular feedback to encourage order set use and promote adherence to time metrics.

Design/Methods:

All patients presenting directly to our comprehensive stroke center ED with ICH were included 12 months before, and 6 months after, the implementation of the Code ICH feedback form. We compared frequency of ICH order set use, time from arrival to antihypertensive therapy and time to anticoagulant reversal, to assess the effect of feedback on caregiver performance.

Results:

Sixty-nine ICH patients were treated in the 12 months prior to introducing feedback. The median age was 65, NIHSS 12, and code ICH order set was used in 43% of cases. Median CT to reversal was 51 minutes (n=14), CT to antihypertensive was 23 minutes (n=19). After ICH feedback started, 27 patients were treated. Median age 60, median NIHSS 14.5, and ICH order set used in 48% of cases. Median CT to reversal agent was 37 minutes (n=5) and CT to antihypertensive agent was 39 minutes (n=20).

Conclusions:

Implementation of Code ICH feedback increased use of ICH order sets by 5% and time from CT to anticoagulant reversal decreased by 24 minutes. Feedback increased appropriate order use, yet results were variable for treatment targets.