{
  "abstract": "Background Variation in minimally invasive surgical (MIS) workflows for intracerebral hemorrhage (ICH) persists across U.S. hospitals, influencing timeliness, and quality of care. To support national quality improvement, fifteen hospitals participated in a multisite review of their ICH MIS pathways. Deidentified process maps were aggregated to characterize current practices and identify crosssite strengths, barriers, and improvement opportunities spanning triage, patient selection, surgical timing, postoperative management, training, and outcomes tracking.Methods Each hospital completed structured processmapping sessions detailing its ICH MIS workflow. Domains included: triage, patient selection criteria, surgical timing and operative processes, postoperative care, training and education, and outcomes measurement. Qualitative analysis of these maps synthesized site-level practices into common themes, focusing on strengths, systemic barriers, and actionable opportunities for standardization and improvement.Results Across institutions, notable strengths included rapid stroke activation procedures, immediate CT/CTA access, EMS prenotification, strong multidisciplinary involvement, and consistent use of postoperative CT imaging. Many centers targeted MIS within 24 hours and demonstrated robust neurocritical care management. Barriers included transfer delays, variable ICH activation pathways, inconsistent surgical selection criteria, operating room bottlenecks, limited intraoperative imaging availability, documentation gaps (e.g., ICH score, mRS), inconsistent training and simulation practices, and weak capture of evacuation percentage and 90day modified Rankin Score (mRS) outcomes. Opportunities spanned the development of unified ICH activation pathways, harmonized MIS candidacy algorithms, improved transfer workflows, standardized timing expectations, structured postoperative bundles, simulationbased training programs, and a unified outcomes scorecard.Conclusion The aggregated process maps revealed meaningful variability in ICH MIS pathways, contributing to delays and practice inconsistency across hospitals. While enthusiasm for MIS adoption and multidisciplinary engagement is strong, systematic gaps remain in activation workflows, data capture, interfacility coordination, and training infrastructure. Implementing standardized pathways, improving documentation systems, and strengthening outcomes tracking represent highimpact opportunities to elevate the quality and consistency of ICH MIS care nationally.Disclosures S. Abelt: None. L. Serdynski: None. S. Simon: None. J. Chen: None. B. Jankowitz: None. C. Matouk: None. D. Altschul: None. P. Cotton: None. J. Bagley: None. J. Coppens: None. K. Ebersole: None. A. Singhal: None. D. Patra: None. W. Mohamed: None. T. Binyamin: None. H. Zeinedinne: None.Abstract E-276 Figure 1Abstract E-276 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Clinical Research, Health Science, American Heart Association, Dallas, TX"
      ],
      "name": "S Abelt"
    },
    {
      "affiliations": [
        "Clinical Research, Health Science, American Heart Association, Dallas, TX"
      ],
      "name": "L Serdynski"
    },
    {
      "affiliations": [
        "Penn State Health Milton S. Hershey Medical Center, Hershey, PA"
      ],
      "name": "S Simon"
    },
    {
      "affiliations": [
        "UC Irvine Medical Center, Orange, CA"
      ],
      "name": "J Chen"
    },
    {
      "affiliations": [
        "Hackensack Meridian Health, Hackensack, NJ"
      ],
      "name": "B Jankowitz"
    },
    {
      "affiliations": [
        "Yale New Haven Hospital, New Haven, CT"
      ],
      "name": "C Matouk"
    },
    {
      "affiliations": [
        "Montefiore Medical Center, Bronx, NY"
      ],
      "name": "D Altschul"
    },
    {
      "affiliations": [
        "University Medical Center of El Paso, El Paso, TX"
      ],
      "name": "P Cotton"
    },
    {
      "affiliations": [
        "Aurora St. Luke’s Medical Center, Milwaukee, WI"
      ],
      "name": "J Bagley"
    },
    {
      "affiliations": [
        "SSM Health Saint Louis University Hospital, St. Louis, MO"
      ],
      "name": "J Coppens"
    },
    {
      "affiliations": [
        "The University of Kansas Medical Center, Kansas City, KS"
      ],
      "name": "K Ebersole"
    },
    {
      "affiliations": [
        "Mass General, Boston, MA"
      ],
      "name": "A Singhal"
    },
    {
      "affiliations": [
        "Cerebrovascular Center Neurosurgery, Cleveland Clinic, Cleveland, OH"
      ],
      "name": "M Bain"
    },
    {
      "affiliations": [
        "IU Health Methodist Hospital, Indianapolis, IN"
      ],
      "name": "D Patra"
    },
    {
      "affiliations": [
        "DMC Detroit Receiving Hospital, Detroit, MI"
      ],
      "name": "W Mohamed"
    },
    {
      "affiliations": [
        "Sutter Eden Medical Center, Castro Valley, CA"
      ],
      "name": "T Binyamin"
    },
    {
      "affiliations": [
        "Memorial Hermann-Texas Medical Center, Houston, TX"
      ],
      "name": "H Zeinedinne"
    }
  ],
  "title": "E-276 Multisite process mapping of hemorrhagic surgical care: variability and opportunities for standardization",
  "uid": "f243bad1-c46b-55b7-8b19-bd729397957c"
}