Quality improvement project: intracranial haemorrhage management in a tertiary stroke unit

<h3></h3> Early hematoma expansion secondary to poor blood pressure (BP) control worsens outcome in patients with intracerebral haemorrhage (ICH). Rapid BP lowering to systolic BP (SBP) 140mmHg within one hour of hospital arrival is a gold standard that is recommended by the National stroke guideline. The SSNAP (Sentinel Stroke National Audit Programme) audit (2018–2022) shows nationwide, only 5% of those eligible for acute BP lowering achieved this target. We audited BP control in ICH patients arriving within 6 hours of onset, with a SBP of 150–220mmHg and no other contraindication to rapid BP lowering as per National stroke guideline. In our first audit (February to June 2021), only 4% of patients eligible for acute BP lowering achieved this within the first hour. We introduced changes including updating local protocol for BP management in ICH, and held targeted education sessions for nurses and doctors. In this re-audit (August to November 2023) on comparable patients, 12% of eligible patients achieved the national targets, showing an improvement. We identify possible areas for further optimisation and propose a multi-disciplinary team approach for a step-change improvement in BP management. We suggest that current guidelines may be too stringent for real world practice under current medical evidence.