Acute Bundle of Care for IntraCerebral Haemorrhage (ABC-ICH): Evaluation of North England Scale-up
What did we do?
We did a qualitative evaluation (collecting and analysing data in the form of words rather than numbers) of how the ABC-ICH care bundle was implemented in hyper-acute stroke units across 6 regions in the North of England.
Why was it important?
About 1 in 10 strokes are caused by bleeding into the brain, known as intracerebral haemorrhage. About a third of people with this type of stroke do not survive beyond one month and many that do survive are dependent on others for their care.
A bundle of care called the ABC-ICH bundle was developed at Salford Royal Hospital between 2015 and 2016. It combines national and international guidelines that allow clinicians to provide systematic care to patients. The bundle comprises:
o Rapid reversal of blood thinning drugs
o Delivery of intensive blood pressure lowering
o A care pathway for quick referral to neurosurgery when indicated.
At Salford Royal hospital, the ABC-ICH bundle was shown to save around 2 lives per month.
The ABC-ICH bundle was then scaled out to the other hyper-acute stroke units in Greater Manchester. We investigated how well it worked in different settings so we could learn lessons for future roll-out.
A quality improvement (QI) project began in August 2021 to introduce the ABC-ICH bundle into stroke units across different regions in the North of England. An app was developed to guide clinicians on how to deliver the ABC-ICH care bundle and collect data.
The qualitative evaluation was needed to understand which aspects of the implementation strategy influenced the delivery of the ABC-ICH bundle across different hyper-acute stroke units. We wanted to know:
1. what local factors impacted how well it was implemented across sites.
2. what lessons we could learn to improve the implementation strategy for future roll-out.
How did we do it?
We did 45 online interviews (29 first interviews and 16 follow-up interviews) with 30 key stakeholders (6 Quality Improvement (QI) project regional leads, 15 QI project nurse leads, 4 QI project consultant leads and 5 nurses delivering the ABC-ICH care bundle) at different hospital trusts across 6 regions in the North of England. We also observed 6 regional collaborative meetings and collected 9 project documents.
What will we do with the findings?
We are in the final stages of analysing the interviews and writing up the findings. The findings will help us to understand how, and under what conditions, the ABC-ICH bundle is effective. This will help to shape the implementation strategy for national roll-out.
Who are we working with?
Downloadable resources
More information
Programme Manager
Gill Rizzello
gill.rizzello@manchester.ac.uk