Abstract DP161: Improved Time to Treatment in Intracerebral Hemorrhage after GWTG Education Initiative

Introduction: There has been a growing effort recently to improve intracerebral hemorrhage (ICH) care. We evaluated the impact of a GWTG ICH quality improvement initiative launched in February 2023 at three campuses of an academic comprehensive stroke center. Methods: We compared treatment times in ICH patients requiring hypertension management (admission SBP ≥150 mmHg) and/or anticoagulation (AC) reversal who were admitted from 1/1/2017-12/31/2022 (pre-initiative) to a similar group admitted after the ICH quality initiative was launched (4/1/2023-4/30/2025) (post-initiative) at three campuses of an academic comprehensive stroke center in New York City. Patients transferred from another facility or with in-hospital ICH were excluded. The initiative consisted of several departmental briefings and announcements on the importance of prompt imaging and administration of treatments, with blood pressure (BP) lowering medications being encouraged to be given in the CT scanner rather than in the ED, and AC reversal agents being more readily available in the ED. Further, designated stroke coordinators started sending out monthly reports of ICH metrics to hospital departments. The primary outcome was the time from CT read to administration of either BP medication or AC reversal agent. Results: Of 530 ICH patients, (N=312 pre-initiative, N=213 post-initiative), 508 received BP medication and 87 received an AC reversal agent. The time from CT read to treatment (either BP medication or AC reversal agent) significantly declined from a median of 24 minutes pre- to 16 minutes post-initiative (P=0.005). This effect was primarily driven by reductions in CT to BP medication administration (median 24 minutes pre- and 13 minutes post-initiative, P=0.002), whereas time to AC reversal agent actually increased (median 44 minutes pre- to 78 minutes post-initiative, P=0.018). There were no differences in other time metrics including last known normal (LKN) to door, door to stroke team, door to CT, door to BP medication, or door to AC reversal, though door to ED provider was significantly lower post-initiative (median 4 minutes pre- to <1 minute post-initiative, P<0.001). Conclusions: A brief education initiative aimed at improving treatment times successfully reduced time to BP medication administration in ICH, though no improvements were seen in time to anticoagulant reversal. Additional sustained education and quality improvement projects are required to further streamline workflow.