UK Stroke Forum 2025 | Implementation of the ICH Assessment, Consultation and Treatment (ACT) care bundle

So in Edinburgh, we’ve been using a care bundle for intracerebral hemorrhage called ICH ACT, which stands for Assessment, Consultation and Treatment. And this care bundle has been rolled out across hospitals in the NHS Lothian region, in the emergency department and among stroke teams. And we know that care bundles improve outcomes for people with intracerebral hemorrhage. So we’ve been doing a population-based audit of people with intracerebral hemorrhage from 2018 to 2021. And over that time period, we looked at how many people had the care bundle used. And we also looked at different components of the care bundle to see whether they were used or whether that increased over the time of the audit. And we found that about half of patients had the care bundle used. But what was particularly good to see was that the use of acute blood pressure lowering increased among all patients across the time period of the study. Some of the other aspects were harder to measure, such as anticoagulation reversal, because actually there’s not that many patients who are eligible for anticoagulation reversal. But we hypothesise that by bringing in a care bundle and providing education to the emergency department, the stroke team and others, we’ve increased awareness about intracerebral hemorrhage as a disease and the urgency of treatment. So even in patients where the care bundle wasn’t documented, people were more likely to have treatments that can make a difference to their outcome.

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