RT Journal Article
SR Electronic
T1 Scale-up of ABC care bundle for intracerebral haemorrhage across two hyperacute stroke units in one region in England: a mixed methods evaluation of a quality improvement project
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e001601
DO 10.1136/bmjoq-2021-001601
VO 11
IS 2
A1 Lisa Brunton
A1 Camilla Sammut-Powell
A1 Emily Birleson
A1 Ruth Boaden
A1 Sarah E Knowles
A1 Clare McQuaker
A1 Stephen Cross
A1 Natalie Greaves
A1 Kyriaki Paroutoglou
A1 Omran Alzouabi
A1 Hiren C Patel
A1 Appukuttan Suman
A1 Khalil Kawafi
A1 Adrian R Parry-Jones
YR 2022
UL http://bmjopenquality.bmj.com/content/11/2/e001601.abstract
AB Background Intracerebral haemorrhage (ICH) accounts for 10%–15% of strokes in the UK, but is responsible for half of all annual global stroke deaths. The ABC bundle for ICH was developed and implemented at Salford Royal Hospital, and was associated with a 44% reduction in 30-day case fatality. Implementation of the bundle was scaled out to the other hyperacute stroke units (HASUs) in the region from April 2017. A mixed methods evaluation was conducted alongside to investigate factors influencing implementation of the bundle across new settings, in order to provide lessons for future spread.Methods A harmonised quality improvement registry at each HASU captured consecutive patients with spontaneous ICH from October 2016 to March 2018 to capture process and outcome measures for preimplementation (October 2016 to March 2017) and implementation (April 2017 to March 2018) time periods. Statistical analyses were performed to determine differences in process measures and outcomes before and during implementation. Multiple qualitative methods (interviews, non-participant observation and project document analysis) captured how the bundle was implemented across the HASUs.Results HASU1 significantly reduced median anticoagulant reversal door-to-needle time from 132 min (IQR: 117–342) preimplementation to 76 min (64–113.5) after implementation and intensive blood pressure lowering door to target time from 345 min (204–866) preimplementation to 84 min (60–117) after implementation. No statistically significant improvements in process targets were observed at HASU2. No significant change was seen in 30-day mortality at either HASU. Qualitative evaluation identified the importance of facilitation during implementation and identified how contextual changes over time impacted on implementation. This identified the need for continued implementation support.Conclusion The findings show how the ABC bundle can be successfully implemented into new settings and how challenges can impede implementation. Findings have been used to develop an implementation strategy to support future roll out of the bundle outside the region.Data are available upon reasonable request. All data relevant to the qualitative evaluation study are included in the article and uploaded as supplementary information. Quantitative data are available upon reasonable request. Requests should be sent to the corresponding author at lisa.brunton@manchester.ac.uk.