Background: The American Heart/American Stroke Association (AHA/ASA) recommends the documentation of a baseline measurement of severity score for spontaneous intracerebral hemorrhage (ICH) patients to provide a baseline measurement for comparison and assist in outlining communication with the patient and caregivers. As a Comprehensive Stroke Center (CSC), it is a requirement of certification to document an ICH Score for patients who are found to have an ICH prior to surgical intervention, or within 6 hours of presentation to the hospital. Documentation of the ICH Score was historically the responsibility of Neurosurgery or Interventional Neurology providers at our facility but often fell out of standards due to either missing documentation, or being documented after 6 hours. Purpose: The focus of this quality improvement project was to increase knowledge and compliance with documentation of ICH scores for ICH patients that met CSC certification requirements and AHA/ASA recommendations for best practice stroke care. Method: Meetings were held with key provider stakeholders including Emergency Department, Hospitalist, Intensivist, Radiology, and Stroke Teams to discuss the recommendations and requirements for documentation, barriers, and process change necessary to meet standards. After discussions, the Stroke Program Manager determined that including the Hospitalist, Intensivist, and Radiology teams in documentation of the ICH Score was necessary to meet best practice documentation standards and utilized the Plan Do Study Act (PDSA) method to initiate and track the process change. Results: Following initiation of the PDSA, the radiologist began documenting the total ICH volume in the radiology report in order to assist the admitting provider, most commonly the intensivist team, to accurately document the ICH Score. Prior to the performance improvement project from January 2023 – September 2023, 46% of cases (13/28) had documented ICH scores, with 38% (5/13) of documented cases being recorded within 6 hours of presentation. After implementation of process change, from October 2023 – July 2025, 93% of cases (40/43) had documented ICH scores, with 90% (36/40) of documented cases being recorded within 6 hours of presentation. Conclusion: Discussion with key stakeholders on barriers of documentation of the ICH score that met best practice and certification guidelines was essential in creating a process change that was successful and sustainable for all teams.
Chelsey Kuznia (Thu,) studied this question.