Abstract WP232: ICH Time To Treatment: A Retrospective Review

Background: Approximately 80,000 Americans have a spontaneous ICH every year. ICH is the deadliest type of acute stroke and disproportionately affects lower resourced populations. The AHA/ASA released a revised ICH guideline in 2022 and Expanded GWTG Stroke adding additional ICH data elements in 2023. Soon after, facilities were invited to join a pilot abstraction with new ICH stroke performance measures, and we were among the first to participate. The guidelines and data elements highlight the need for blood pressure control and anticoagulant reversal quickly for this critical patient population. Method: The method applied was a retrospective review of ICH patients’ blood pressure control and reversal times in a CSC within a mid-sized city in the Southeastern United States. The period included in this review was a sample of ICH patients from January 2024 to December 2024. Review consisted of door to antihypertensive agent timing, type of antihypertensive medication administered, door to reversal agent timing, and the timeliness of patients to a sustained BP <150 systolic. Results: The median door to antihypertensive agent time was 69 minutes. The median door to reversal agent time was 94 minutes. 66% of patients had a sustained blood pressure of less than150 systolic within an hour of their treatment time. Approximately half of the patients were treated with an IV bolus antihypertensive medication and half started on an IV drip antihypertensive medication. Conclusion: The data review reinforced the need for faster blood pressure control, decreased reversal times, and a more standardized treatment protocol for ICH patients to mirror the 2022 ICH guidelines. Our data found door to antihypertensive times and reversal times longer than the AHA/ASA goals. Resulting from the data review, this facility will implement a performance improvement project to lower times to antihypertensive medication administration, obtain a quicker sustained BP of less than 150 systolic, and reduce times of reversal agents being administered. An ED ICH orderset has been developed and will be implemented to help obtain these goals. The GWTG ICH layer will help the facility track their progress and provide higher quality care to ICH patients.