Introduction: The ‘ABC’ care bundle for intracerebral haemorrhage (ICH) was developed and implemented at Salford Royal Hospital and reduced 30-day case fatality in 2015-2016 by 35%. Implementation of the bundle was scaled out across the two other hyperacute stroke units (HASUs) in Greater Manchester from April 2017. A mixed-methods evaluation was conducted alongside. Methods: A harmonised quality improvement register at each HASU captured consecutive ICH patients from 01/10/2016-30/03/2017 (pre-launch) and 01/04/2017-30/03/2018 (post-launch). Quantitative data are presented as median and interquartile range. Qualitative evaluation captured how the bundle was implemented across sites; it involved: 33 interviews with implementation teams/clinicians; 79 hours of non-participant observation; analysis of documents. Results: HASU1 significantly reduced anticoagulant reversal door-to-needle time (134 min [120– 392; n=14] pre-launch vs 72 min [63–108; n=21] post-launch; p<0.001) and intensive BP lowering door-to-target time 336.5 min [199-856, n=22] pre-launch vs 83.5 min [59.5-114.5, n=30] post-launch; p<0.001). 30-day case fatality at HASU1 fell from 34.3% (n=70) to 26.8% (n=97, 21.9% relative reduction), but was not statistically significant. No statistically significant changes in care process/ case fatality occurred at HASU2. Qualitative evaluation identified importance of facilitation: all-site quarterly meetings encouraged a learning culture between HASUs; robust planning before bundle launch contributed to early adoption at one site; close monitoring of data helped identify missed targets and provide early feedback to staff. Contextual changes over-time impacted upon implementation across sites, identifying a need for continued implementation support. Conclusion: Findings will be used to support an implementation strategy to test bundle in other areas.
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