Intracerebral Haemorrhage

This information is aimed at professionals supporting stroke survivors in the region.

Acute Bundle of Care for Intracerebral Haemorrhage (ABC-ICH) project

Intracerebral haemorrhage causes 1 in 10 strokes and has a far higher risk of death and disability than ischaemic stroke. The ‘ABC’ care bundle for intracerebral haemorrhage was developed and implemented at Salford Royal Hospital in 2015-16 and reduced 30-day deaths by one-third, saving two lives per month at Salford. The bundle consists of guideline-recommended interventions:

  • Rapid Anticoagulant reversing
  • Intensive Blood pressure lowering
  • A Care pathway for prompt neurosurgical referral

The ABC care bundle was scaled-up in Greater Manchester in 2017-18. A qualitative evaluation has refined the implementation strategy and the ABC-ICH app was developed and piloted. The app guides care bundle delivery and captures key process data for automatic display in a linked dashboard. Version 2 is currently under development.

A phased scale-up across the North of England is planned. Six regional clusters will be established based on neurosurgical units (Preston, Walton Centre, Sheffield, Hull, Middlesbrough, Newcastle) and their referring stroke units. Each cluster will have a Clinical Project Lead and Neurosurgical Lead and each hospital site an Implementation Team composed of a Lead Consultant, Lead Nurse and a Data Lead. Clusters will be randomly allocated to a staggered bundle launch at intervals of one month. The project will be supported by a Central Project Team in Manchester, with face-to-face meetings three months prior to launch and then three and six months after. The ABC-ICH app and dashboard will facilitate the project.

A quantitative evaluation using Sentinel Stroke National Audit Programme (SSNAP) data will be conducted to determine the association between admission after bundle launch, case fatality and disability at six months. SSNAP already routinely captures the data needed for the conduct and analysis of the project. A further qualitative evaluation will be conducted to understand how the implementation strategy could be further refined for a subsequent national scale-up.

The project will commence in 2021 with a 6-month project set-up period. This will be followed by a 14-month period of bundle roll out and active implementation. A final 6-month period will allow data analyses to commence and for the final 6-month outcome data to be complete. Results will be disseminated and if successful, plans made for a national roll out of the ABC care bundle.


Find out more

Slides summarising results of introducing the bundle at Salford

Care pathway Standard Operating Procedure and referral guidelines

How do I calculate ICH volume?

Summary of ABC bundle


Funding and support

The project is funded by the Health Foundation and Connected Health Cities and supported by Haelo, a not for profit improvement science centre based in Salford, through funding provided by the Manchester Academic Health Sciences Centre.