Delivering an Acute Bundle of Care for Intracerebral Haemorrhage (ABC-ICH) in Greater Manchester

Intracerebral haemorrhage (bleeding in the brain) has a far higher risk of death and disability than other types of stroke and leaves over half of people who survive dependent on others for day-to-day care.

The aim of this project, run by Salford Royal NHS Foundation Trust, was to achieve a 10% reduction in the number of patients who died or were severely disabled six months after presenting to a hyperacute stroke unit (HASU) with acute intracerebral haemorrhage.

It involved implementing an evidence-based ‘ABC care bundle’ (Anticoagulant reversal, Blood pressure lowering and a redesigned Care pathway allowing access to neurosurgery) at three HASUs across Greater Manchester. HASU teams met quarterly for collaborative learning sessions and each identified and addressed local barriers to ABC bundle delivery, secured executive leader and clinician buy-in, and held launch events at their hospitals.

Evaluation is currently being finalised, but marked improvements in anticoagulant reversal and intensive blood pressure lowering have been observed. Success varied across the different sites, with the best results being attributed to a motivated team with sufficient seniority to drive change and a good baseline understanding of quality improvement.

A key area of learning was around the development of an app to guide care bundle delivery by the stroke team and capture key process data automatically. Complex and unanticipated regulatory and technological barriers delayed the app’s implementation, which is expected by mid-2018.

The project team are now planning follow-up trials to establish whether the benefits they observed with the ABC bundle can be replicated and scaled up.

Contact information

For more information about this project, please contact Dr Adrian Parry-Jones, Consultant Neurologist, Salford Royal NHS Foundation Trust.