Code Hemorrhage: A Multidisciplinary Approach to Improving Outcomes for Spontaneous Intracranial Hemorrhage
Objective:
To establish a Code Hemorrhage protocol aimed at improving patient outcomes for spontaneous intracranial hemorrhage (sICH), a condition with a high mortality rate.
Background:
Spontaneous intracranial hemorrhage (sICH) is the deadliest form of stroke, accounting for 10-15% of all strokes, with mortality rates as high as 35-52%. Prolonged hospitalizations add financial strain to patients and the healthcare system, emphasizing the need for timely management, including blood pressure control and reversal of anticoagulant or thrombolytic therapies. Institutions are increasingly adopting Code Hemorrhage protocols to reduce variability in care and outcomes.
Design/Methods:
This initiative has three phases:
1. Phase 1 - Data Collection: Beginning in July 2023, a retrospective review of sICH patients was conducted using ICD-10 code I62.9 (nontraumatic ICH, unspecified). Data included last known well, arrival time, NIHSS/ICH scores, CT/CTA head results, initial blood pressure, intervention times, and outcomes.
2. Phase 2 - Questionnaire Implementation: Starting in July 2024, neurology residents responding to stroke alerts collected the same parameters to assess interventions in real-time and reduce delays in care.
3. Phase 3 - Protocol Implementation: In collaboration with Emergency Medicine, a Code Hemorrhage protocol will be incorporated into institutional guidelines to standardize sICH management.
Results:
Phase 1 data demonstrated variability in sICH management, highlighting the need for a consistent protocol. Phase 2 showed that increased awareness of time-to-intervention led to reduced delays in care. With the implementation of the Code Hemorrhage protocol, we expect more efficient care for sICH.
Conclusions:
Spontaneous intracranial hemorrhage remains a devastating type of stroke, associated with high mortality and extended hospital stays. The establishment of a multidisciplinary Code Hemorrhage protocol can reduce variability in care, improve time to intervention, and ultimately enhance patient outcomes.
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