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Updated: Feb 4, 2026

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Code Intracerebral Hemorrhage: A Quality Improvement Pilot Study.

Ehab Harahsheh1, Oana M Dumitrascu1, Katelyn Marsden2

  • 1Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ.

Mayo Clinic Proceedings. Innovations, Quality & Outcomes
|February 2, 2026
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Summary
This summary is machine-generated.

Implementing a Code ICH protocol improved adherence to acute intracerebral hemorrhage management guidelines, ensuring timely treatments and assessments for patients.

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Area of Science:

  • Neurology
  • Quality Improvement Science
  • Emergency Medicine

Background:

  • Acute spontaneous intracerebral hemorrhage (ICH) management requires adherence to national guidelines.
  • Existing care gaps may delay critical interventions in emergency department settings.
  • Standardized protocols are essential for optimizing patient outcomes in acute neurological emergencies.

Purpose of the Study:

  • To enhance adherence to guideline-recommended practices for acute spontaneous intracerebral hemorrhage (ICH) management.
  • To implement and evaluate a quality improvement initiative within an emergency department setting.
  • To reduce delays in antihypertensive treatment, anticoagulation reversal, and neurological assessments for ICH patients.

Main Methods:

  • A Define-Measure-Analyze-Improve-Control (DMAIC) framework was employed for a quality improvement initiative.
  • A standardized 'Code ICH' protocol and electronic medical record power plan were developed.
  • Key performance indicators included timely antihypertensive administration, anticoagulation reversal, repeat CT scans, and specialist consultations.

Main Results:

  • High adherence rates were achieved for antihypertensive treatment (92-100%) and anticoagulation reversal (100%).
  • Repeat CT scans at 6 hours were completed in 93-100% of patients.
  • Vascular neurology and neurosurgery assessments were prompt, with consultations occurring in 87% of cases.

Conclusions:

  • A structured 'Code ICH' protocol significantly improved adherence to acute ICH management guidelines.
  • The initiative facilitated prompt neurological assessments and timely interventions.
  • Sustainability plans were developed to maintain protocol compliance and improve patient care.