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Improving Blood Pressure Management and Disease Severity Documentation in Patients With Acute Intracerebral
Oana M Dumitrascu1, Cumara B O'Carroll1, Vanesa Vanderhye1
1Department of Neurology, Mayo Clinic, Phoenix, AZ.
Insights
Effective education and order-set changes improved blood pressure control and intracerebral hemorrhage (ICH) score documentation in acute ICH patients. This quality improvement initiative achieved significant gains in guideline adherence and patient care.
Area of Science:
- Neurology
- Quality Improvement Science
- Clinical Practice Management
Background:
- Acute intracerebral hemorrhage (ICH) requires prompt management for optimal patient outcomes.
- Adherence to guideline-based blood pressure targets and timely ICH score documentation are critical.
- Existing care pathways may present challenges in achieving these critical management goals.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative focused on improving blood pressure control and ICH score documentation in acute ICH patients.
- To achieve at least 80% adherence to guideline-based systolic blood pressure (SBP) control (≤140 mm Hg).
- To ensure at least 80% of patients have their ICH score documented within 6 hours of admission.
Main Methods:
- A Define-Measure-Analyze-Improve-Control (DMAIC) quality improvement project was conducted.
- Interventions included targeted education for healthcare professionals and modifications to hospital admission order sets.
- Neurovascular stakeholders provided input to refine the process and interventions.
Main Results:
- Post-intervention, systolic blood pressure control improved from 50% to 92.3% and 100% at 4 and 8 months, respectively.
- ICH score documentation within 6 hours increased from 42.3% pre-intervention to 84.6% and 85.7% at outcome measurements.
- Stakeholders reported high satisfaction with the implemented changes.
Conclusions:
- Effective education and optimized order sets are key drivers for adopting guideline-based clinical practices in acute ICH management.
- This quality improvement initiative demonstrates potential to enhance patient outcomes, staff efficiency, and stroke center accreditation.
- The successful model warrants broader implementation across healthcare systems.
Objective:
To ensure prime blood pressure management and intracerebral hemorrhage (ICH) score documentation within 6 hours of arrival and/or before any intervention in patients admitted to Mayo Clinic Hospital with acute ICH.
Patients And Methods:
A quality improvement initiative was conducted between September 29, 2015, and May 30, 2017, following the Define-Measure-Analyze-Improve-Control methodology. Our prespecified goals for the first 8 months postintervention were that at least 80% of patients with ICH will have systolic blood pressure (SBP) control as per guideline-based recommendations (SBP ≤140 mm Hg) and at least 80% will have ICH score documented within 6 hours postadmission. Neurovascular stakeholders' feedback was included in the process development. Practice gaps and their leading causes were identified and served rational interventions' planning. Education and admission order-set modifications were chosen as intervention methods.
Results:
At 4 (first measurement, n=13) and 8 months (second measurement, n=15) postintervention, 92.3% and 100% of patients with ICH, respectively, reached the target SBP, compared with 50% in the preintervention group (comparison group, n=26); 84.6% and 85.7% of the patient population had the ICH score documented at the first and second outcome measurement, respectively, compared with 42.3% in the preintervention group. Stakeholders reported good satisfaction with the novel applications. Sustainability plans and future directions were established.
Conclusion:
Effective education methods enhance the introduction of guideline-based clinical practices. This quality improvement project has the potential to impact patient outcomes, staff efficiency, and stroke centers' maintenance of certification and quality care recognition. This initiative warrants implementation at hospitals across all Mayo Clinic campuses and nationwide.
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