Current and evolving management of subarachnoid hemorrhage

Transfer time to a high-volume center for patients with subarachnoid hemorrhage does not affect outcomes

OBJECTIVES

The objective of our study was to examine patients with aneurysmal subarachnoid hemorrhage transferred and directly admitted to our institution in order to determine how transfer time affects outcomes.

METHODS

A retrospective cohort study was performed of all patients undergoing treatment for aneurysmal subarachnoid hemorrhage between 2005 and 2012 at the University of Michigan. Variables, including transfer time, were tested for their independent association with the primary outcomes of symptomatic vasospasm and 12-month outcome as well as secondary outcomes of aneurysm rebleeding and 12-month mortality.

RESULTS

During the study period, 263 (87.4%) patients were transferred to our institution and 38 (12.6%) were directly admitted for treatment of aneurysmal subarachnoid hemorrhage. Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. Higher Hunt-Hess grade was associated with the occurrence of symptomatic vasospasm as well as with poorer 12-month outcome.

CONCLUSIONS

Transfer time was not associated with the occurrence of symptomatic vasospasm, 12-month outcome, rebleeding, or 12-month mortality. We believe our data argue that protocols should emphasize early resuscitation and stabilization followed by safe transfer rather than a hyperacute transfer paradigm. However, transfer time should be minimized as much as possible so as not to delay time to definitive treatment.

Quality Improvement Project: analysis of efficiency of current order set for the diagnostic workup used to evaluate neurogenic stress myocardium in aneurysmal subarachnoid hemorrhage

PURPOSE

To evaluate patterns of utilization of the aneurysmal subarachnoid hemorrhage (aSAH) protocol order set for neurogenic stress myocardium (NSM).

DATA SOURCES

Retrospective chart review.

CONCLUSIONS

The results of this study demonstrate that protocol order sets can be prone to omissions, variations in practice, and delays.

IMPLICATIONS FOR PRACTICE

Education and implementation of an intervening compliance monitor are essential to improve utilization and correctness in use of the aSAH protocol order set for NSM. Advance practice nurses (APNs) or nursing staff could provide this service. This would improve teamwork, improve efficiency of care delivery and utilization of resources, promote leadership and improved outcomes, and promote relationship-based care.