Improving care for intracerebral haemorrhage (ICH) patients
Intracerebral haemorrhage (ICH), where bleeding occurs within the brain tissue, is a life-threatening type of stroke affecting over 10,000 people in the UK each year. To improve the quality of care for these patients, the ‘ABC’ care bundle for ICH was developed based on our research and is now in use at 28 hospitals across the north of England.
- At Salford Royal Hospital, 30-day ICH mortality was reduced by 33%.
- ABC-ICH is now used at 28 NHS hospitals.
- ABC-ICH is included in the NHS Rightcare stroke toolkit.
Around 30-40% of ICH patients typically do not survive to one month of the stroke, and only 20% of survivors regain independence. There are few effective treatments but improving how effectively existing treatments are carried out can lead to improved patient outcomes.
The ABC-ICH care bundle was developed to improve the quality of care received by ICH patients.
Dr Adrian Parry-Jones
Adrian is a Consultant Vascular Neurologist at the Manchester Centre for Clinical Neurosciences and holds a Stroke Association Margaret Giffen Reader Award.
The ABC-ICH bundle
The bundle consists of guideline-recommended interventions based on our research.
A - Rapid Anticoagulant reversing
In collaboration with Atte Meretoja from the University of Melbourne, Adrian Parry-Jones co- led a multicentre observational study, which was the largest ever study to demonstrate that clotting factor replacement reduced mortality after ICH.
B - Intensive Blood pressure lowering
Adrian Parry-Jones led INTERACT2 at Salford (the top UK recruiter). This phase III trial demonstrated that a strategy of intensive blood pressure lowering in acute ICH reduced disability and improved quality of life at 90 days.
C - A Care pathway for prompt neurosurgical referral
Our retrospective study demonstrated the factors associated with transfer to neurosurgical care and that transfer was associated with lower risk of death compared to care under stroke medicine, after adjusting for key prognostic factors.
How has the ABC-ICH bundle helped?
Reduction in patient deaths
ABC-ICH was implemented at Salford Royal Hospital in 2015-16, where it reduced the number of patients who died within a month of their ICH by 33%, saving 24 lives annually. The project has since been scaled up, initially in two further Greater Manchester hospitals and, from August 2021, across the north of England. ABC-ICH is now in use at 28 NHS hospitals covering a population of over 11 million. If the benefits seen at Salford Royal are replicated, over 250 lives a year could be saved.
App developed to save NHS staff time
We have also developed and piloted a clinician-facing ABC-ICH app and dashboard to provide clinicians with key information at the bedside and allow simple, real-time capture of key patient data. This automates audit and feedback, freeing NHS staff time to focus on improving care, and has been made available to all hospitals using ABC-ICH.
Included in NHS Rightcare toolkit
In August 2022, ABC-ICH was included as guidance and best practice for ICH management in NHS England’s Rightcare Stroke Toolkit, which aims to support health and care systems nationally to improve care quality.
With funding from the Stroke Association, we are now working to determine whether using the ABC-ICH care bundle also reduces long-term disability in ICH stroke survivors and assessing the cost-effectiveness of its use.
A parallel project is evaluating the implementation strategy and seeking improvements as we aim to roll out nationally in the coming years.
We are also in discussions with colleagues in Norway and Sweden who are in the early stages of planning national projects similar to ABC-ICH to implement and evaluate a care bundle approach to care for patients with ICH.
- Which factors influence decisions to transfer and treat patients with acute intracerebral haemorrhage and which are associated with prognosis? A retrospective cohort study
- Reversal strategies for vitamin K antagonists in acute intracerebral hemorrhage
- Scale-up of ABC care bundle for intracerebral haemorrhage across two hyperacute stroke units in one region in England: a mixed methods evaluation of a quality improvement project
- An intracerebral hemorrhage care bundle is associated with lower case fatality