“ICH-CARE”: ICH-integrated care for accelerated response to intracerebral hemorrhage using a phased approach

Objective Intracerebral hemorrhage (ICH) is a deadly stroke subtype requiring ultra-early bundled interventions. The Mayo Clinic Comprehensive Stroke Center implemented a “ICH Phases” three-tiered communication system to accelerate multidisciplinary care. This article introduces this system and functions as a preliminary small-sample pilot for a larger underway prospective study Methods We conducted a retrospective before-and-after study of spontaneous ICH patients admitted between 2021 and 2025. The pre-implementation cohort included 46 patients (2021–2022), and the post-implementation cohort included 67 patients (2023–2025). Adherence to American Heart Association/American Stroke Association (AHA/ASA) acute ICH quality measures, door-to-CT time, ICH score documentation, antihypertensive treatment initiation, anticoagulation reversal, venous thromboembolism (VTE) prophylaxis, and discharge antihypertensive prescribing were compared before and after the implementation of new system. Results Included were 113 patients (46 pre; 67 post). Post-implementation improvements included: CT acquisition within 25 min (from 34.8% to 68.7%), antihypertensive treatment within 30 min (from 21.1% to 48.2%), anticoagulation reversal within 120 min (from 66.7% to 75.0%), VTE prophylaxis within 24 h (from 71.7% to 91.0%), and discharge antihypertensive prescriptions (from 66.7% to 83.7%). ICH score documentation within 6 h remained high (from 82.6% to 83.6%). Conclusion This structured communication system effectively optimizes multidisciplinary communication and coordination and accelerates hyperacute ICH care.