Refining Clinical Management Advice From Radiology for Intracerebral Haemorrhage: A Two-Cycle Clinical Audit With Intervening Service Improvement

Spontaneous intracerebral haemorrhage (ICH) is a time-critical neurological emergency associated with high morbidity and mortality.Management guidelines recommend prompt blood pressure reduction, anticoagulation reversal where indicated, and early involvement of the stroke team, with no routine role for surgical intervention in small, deep, uncomplicated haemorrhages.At University Hospitals of Leicester NHS Trust, a pattern was identified in which radiology reports for this patient group frequently recommended neurosurgical consultation without associated guidance towards evidence-based medical management, contributing to delays in time-critical interventions.A two-cycle clinical audit with an intervening service improvement initiative was conducted to assess and improve the alignment of radiology reporting with guideline-directed management.Following a targeted educational intervention for reporting clinicians and promotion of a stroke-specific imaging request pathway, the distribution of management advice in radiology reports differed significantly between audit cycles, with inappropriate surgical referral advice eliminated entirely and appropriate medical management advice increasing from 17% to 52% of all reports.The rate of surgical consultation fell from 56% to 15%.Timely antihypertensive administration showed a nonsignificant improvement.These findings support targeting radiology reporting practice as a practical adjunct to broader ICH care bundle implementation.