Code Intracerebral Hemorrhage: A Quality Improvement Pilot Study

Objective: To improve adherence to current national guideline-recommended practices for managing acute spontaneous intracerebral hemorrhage (ICH) in patients presenting to Mayo Clinic Arizona emergency department. Patients and Methods: We launched a quality improvement initiative from April 1, 2024, to April 30, 2025, using the Define-Measure-Analyze-Improve-Control framework. Initial 6-month goals included: (1) administering antihypertensive treatment within 30 minutes of identifying ICH in ≥80% of patients with systolic blood pressure >150 mm Hg; (2) reversing anticoagulation within 45 minutes in ≥80% of anticoagulated patients; (3) performing repeat computed tomography head scans at 6 hours post-ICH identification in ≥80% of patients; and (4) initiating vascular neurology and neurosurgery assessments within 15 minutes of ICH recognition. Identified care gaps, informed by stakeholder feedback, led to the creation of a standardized Code ICH protocol and an emergency department-specific ICH electronic medical record power plan. Results: Twenty patients were included in the 1-6-month interval (Code ICH activated in 15/20 (75%) of eligible patients) and 12 patients in the 7-13 month interval (Code ICH activated in 8/12 [67%]). Antihypertensive medication administration within 30 minutes occurred in 92% (11/12) and 100% (3/3) of patients with systolic blood pressure >150 mm Hg. Anticoagulation reversal within 45 minutes was achieved in all eligible patients (100%, 2/2). Repeat computed tomography scans at 6 hours post-ICH identification were completed in 93% (11/12) and 100% (8/8) of patients at respective time points. Immediate vascular neurology evaluations were performed in all patients, and neurosurgery consultations occurred in 87% (20/23). A sustainability plan was developed postintervention to maintain continued Code ICH activation and compliance. Conclusion: Implementation of a structured Code ICH protocol facilitated prompt neurological assessments and adherence with current national acute ICH management guidelines.