Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Improving Earlier Access to Hyper-Acute Intracerebral Treatments As Supported By a Valid Collaborative Clinical Guideline. (#205)

Alicia Tyson 1 , Martin Punter 1 2 , Anna Ranta 1 2 , Jane ODonnell 3
  1. Wellington Regional Hospital, Wellington , New Zealand, Newtown, NEW ZEALAND, New Zealand
  2. Department of medicine, Otago university, Wellington, New Zealand
  3. School of Nursing, Massey University , Auckland, New Zealand

Background: Intensive blood pressure (BP) lowering and anticoagulation reversal improve intracerebral haemorrhage (ICH) patient outcomes and implementing guidelines in conjunction with clinician engagement may improve compliance.

Aims: To audit Wellington Regional Hospital (WRH) ICH time metrics, patient outcomes and, to ascertain barriers/facilitators to implementing evidence-based ICH treatments.

Methods: This mixed method study includes a retrospective audit conducted for all WRH ICH patients between 1st January and 31st December 2021. The audit considered BP treatment and targets, anticoagulation reversal and patient outcomes.  A literature review and collaborative multi-disciplinary approach informed a guideline update and implementation. Clinicians were surveyed pre-and-post implementation which supplemented the guideline update.

Results:  Forty-three patients were included in the audit. Anticoagulation reversal occurred in 4/10 (40%) patients in 129 minutes (IQR 77-215) from arrival. Forty-one patients were hypertensive on arrival of whom 16/41 (39%) received antihypertensive medication within 60 minutes and a further 13/41 (32%) within 24 hours (median 52 minutes; IQR 36-109). Early deterioration rates, defined as GCS drop of 2 or NIHSS rise of 4) were 13/41 (32%), with 11/41 (25%) three-month mortality.

The survey found that guideline confidence improved post revision (3.6/5 vs 3.8/5) and user-friendliness (3.8/5 vs 4.1/5). Specific ICH treatment knowledge improved post-revision including, correctly naming BP parameters 39/59 (66%) to 29/37 (78%), time to target BP (60 minutes) (44/63 (70%) to 35/37 (95%)) and, more respondents reversing anticoagulation (54/66 (82%) vs 36/37 (97%)).

A multidisciplinary stakeholder engagement approach to guideline revision resulted in a collectively endorsed protocol.

Conclusion:  The WRH ICH guidance time metrics were not met, adherence was inconsistent, and advice did not fully align with international literature. Clinician engagement and guideline revision increased ICH treatment knowledge, resulting in increased confidence and user-friendliness. Further research is needed to assess impact of the new guideline on adherence and patient outcomes.