A Learning Health System for Stroke: ABC-ICH Care Bundle

Whilst using the ABC care bundle for Patients with Intracerebral (brain) Haemorrhage (ICH), one Hyper Acute Stroke Unit observed a reduction of around 22% in the number of patient deaths within 30 days. 


In order to help improve the care for patients who suffer the most serious type of stroke, caused by an Intracerebral (brain) haemorrhage (ICH), the ABC care bundle was developed in 2015- 16 at Salford Royal Hospital NHS Foundation Trust. When the care bundle (ABC-ICH) was introduced to Salford Royal NHS Foundation Trust, one of the three Hyper Acute Stroke Units (HASUs) in Greater Manchester, the number of patients dying within 30 days was reduced by 35% in 2015 and 2016, an average of two lives saved per month. Through GM CHC, the ABC-ICH care bundle was also introduced into two other HASUs in Greater Manchester from April 2017 onwards and an easy-to-use app and supporting dashboard was developed. During the initial implementation phase, one HASU reduced the number of patient deaths within 30 days by around 22%. The HASU team also demonstrated marked improvements in the care process including a reduction in door-to-needle time for initiating treatment (anticoagulant reversal) by nearly half (from 134 minutes to 72 minutes). As a result of this workstream, a second version of the ABC-ICH app is being developed for scale up across the North of England including Newcastle, Middlesbrough, Hull, Sheffield, Liverpool, Preston with the support of the Academic Health Science Networks. The ABC bundle consists of: ‘A’ – Rapid reversal of Anticoagulation; ‘B’ – Optimal delivery of intensive Blood Pressure lowering and; ‘C’ – Care pathway to ensure consistent and timely access to neurosurgery. Scaling up for impact

  • The care of ICH patients were monitored before the bundle was introduced and afterwards to compare the impact that it had on patient care and outcomes.

  • The app was piloted at one of the HASUs with key staff being interviewed and observations carried out to find out how well the app was being received and used in the HASU setting.

  • There were some clear benefits to patients from using the bundle in ICH care, such as less time taken for patients to receive the care and medication they needed and better management of patients’ blood pressure.

  • The user-centred factors of using a digital platform via a mobile app were also impacting on use of a digital platform through an app were also observed prior to designing the implementation programme.


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