(1361) Improving Time to Treatment Metrics in Intracerebral Hemorrhage (ICH) Patients: A CODE ICH Report

Introduction: Current American Heart Association (AHA) Get With The Guidelines (GWTG) stroke metrics aim for certain door-to-diagnostic or therapeutic goals in acute ischemic stroke patients, however, there are still no established guidelines for intracerebral hemorrhage (ICH) despite worse outcomes and higher mortality. Here, we present initial efforts to improve ICH care through enrollment in the GWTG-Stroke ICH Layer.

Methods: In a retrospective cohort analysis using data collected from 4/1/2023-6/30/2024 in three NYC comprehensive stroke centers that became pilot sites for GWTG (post pilot), we identified ICH patients who required treatment for hypertension (initial SBP>150 mmHg) and/or anticoagulation reversal. We compared time to diagnostics and treatment metrics to data collected from 1/1/2017-12/31/2022 (pre pilot). We excluded any direct hospital transfers and in-hospital events.

Results: We identified a total of 680 ICH patients, (N=477 pre pilot, N=203 post pilot). Age (60 vs 70), sex (39% vs 42% female), admission NIHSS (11 vs 8), and race (49% vs 49% white) did not differ significantly across the groups. No significant improvements were found in last-known-normal (LKN)-to-door-time (355 min vs 296 min, P=0.732), door-to-CT-time (23 vs 23 min, P=0.814), door-to-CT-read-time (26 min vs 36 min, P=0.003), and door-to-treatment-times (antihypertensive: 61 min vs 58 min, P=0.764; anticoagulation reversal 44 min vs 54 min, P=0.682; any treatment 62 min vs 61 min, P=0.732). However, door-to-ED-provider time (4 min vs 3 min, P=0.045) as well as CT-to-antihypertensive-time improved significantly (28 min vs 18 min, P < 0.001) in the post pilot group.

Conclusions: Our study demonstrated significant shorter door-to-ED-provider-times and faster administration of antihypertensive medication following ICH confirmation on CT read after enrollment in the GWTG GWTG-Stroke ICH Layer. However, there is still need for implementation of stricter guidelines for ICH care as many other metrics lacked improvement (Code ICH). Further investigation could lead to identifying barriers and obstacles that hinder efficient ICH care.