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Neurosurgery quality indicators

Time from emergency admission with sub-arachnoid haemorrhage to surgery or coiling, including cases where intervention was deferred for medical reasons.

What is a sub-arachnoid haemorrhage (SAH)?

A sub-arachnoid haemorrhage is a sudden bleed in the spaces around the brain and is most commonly caused by an aneurysm. An aneurysm is a balloon-like swelling which forms in the wall of an artery. Aneurysms are weaker than normal arteries and can rupture, causing a bleed.

Treatment

Traditionally, aneurysms causing sub-arachnoid haemorrhage required major brain surgery and whilst this is still the case for some aneurysms the majority are now treated by coiling. Coiling is a specialist technique carried out by neuroradiologists. In this method, aneurysms are either sealed off or bypassed using special coils or stents inserted into the artery itself, via a tube passed into a large artery in the groin. This procedure has the major advantage of not requiring the skull to be opened.

Further information about sub-arachnoid haemorrhage diagnosis and treatment is available from the Brain and Spine Foundation website.

How is the Trust doing?

Average time delay (days) from emergency admission with sub-arachnoid haemorrhage to surgery or coiling including cases where intervention was deferred for medical reasons

Rolling year to date (March 2012 – February 2013)	1.6
Rolling 2 years (March 2011 – February 2013)	1.3

Percentage of emergency sub-arachnoid haemorrhage patients who had surgery or coiling within two days, including cases where intervention was deferred, for medical reasons

Rolling year to date (February 2012 – January 2013)	80.8%
Rolling 2 years (February 2011 – January 2013)	85.5%

All patients with suspected sub-arachnoid haemorrhage require prompt investigation, although not all of them will have aneurysms that require treatment. Further, not all patients with aneurysms are well enough to be treated within 48 hours and it is therefore sometimes necessary to delay treatment for medical reasons.

The data available at present do not, unfortunately, differentiate between these different categories of patients and the mean time to treatment includes cases where treatment delay was an elective medical decision. Hence, we would not expect our mean time to treatment to be, necessarily, within 48 hours. We are seeking methods of refining our data for future analyses.

Why are these indicators important?

Sub-arachnoid haemorrhage is a life-threatening condition that usually strikes without warning and can be devastating in its effects upon the affected individual, or even fatal. Patients who survive remain at risk of suffering another, potentially lethal bleed, so prompt investigation and treatment are essential.

UHB’s dedicated neurosurgical unit provides specialist investigation and treatment 24 hours a day, seven days a week (including weekends and public holidays). The Trust aims to treat all suitable adult patients within 48 hours of presentation of the bleed and earlier if possible.

How do we measure these indicators?

Average time difference (in days) between the emergency referral for treatment and the first operation date for all patients admitted with sub-arachnoid haemorrhage.