Special Systems of Care Considerations in Intracerebral Haemorrhage

Abstract

Stroke systems of care apply to all stroke types, haemorrhagic and ischemic. This chapter discusses some core features and operating principles along the continuum of stroke care that can frame the organization of systems of care for ICH: (a) prevention and public awareness, (b) hyper-acute and acute management, and (c) rehabilitation and community reintegration. To have a stroke system of care means that care is coordinated and optimized along the entire stroke care continuum, from primary prevention to rehabilitation. These include the designation of comprehensive stroke centres, development of regional strategies to guarantee appropriate interventions like emergency medical services routing policies, pre- and in-hospital care protocols, stroke unit care, as well as inter-provider collaboration, the use of telemedicine to aid patient care in remote facilities, access to post-stroke rehabilitation, and the integration of quality improvement programs. Stroke systems of care therefore have a central role in education, infrastructure and protocol development, institutional accreditation, and continuous quality improvement across the continuum of stroke care. An integrated approach to stroke care, with carefully designed policies that address the complex challenges and care needs along each step of the continuum, can help ensure that patients with ICH have the best chance at disability-free survival.