Abstract Body: Background: Patients who arrive at the emergency department (ED) with transient ischemic attacks (TIA) are at an increased risk of experiencing a stroke. These patients must undergo appropriate medical assessment, receive treatment for risk factors, and be educated on how to reduce their risk for stroke. The conventional TIA evaluation process often results in long ED stays or preventable hospital admissions. A significant portion of the evaluation may be safely conducted on an outpatient basis, if urgent follow-up care is readily available. With hospitals frequently facing capacity challenges, the stroke team sought an alternative solution to the conventional TIA evaluation model.
Objective: We aimed to decrease inpatient TIA admissions by implementing a process where patients can have outpatient evaluation within 48-72 hours of ED discharge. During the TIA clinic visit the patient meets with a vascular neurologist to formulate a treatment plan. This includes referrals to relevant experts, medications, and counseling for lifestyle modifications. If indicated, the patient will be scheduled for an MRI within 24 hours and/or an echocardiogram within 48 hours of the TIA clinic visit. Stroke nurses are available to reinforce lifestyle counseling by reviewing the signs and symptoms of stroke, and how to manage individual risk factors.
Methods: Key stakeholders in multiple departments collaborated to optimize the workflow, utilizing dedicated order sets. ED providers evaluate patients presenting with TIA symptoms and identify suitable candidates for the TIA clinic. Eligible patients undergo diagnostic tests in the ED and receive baseline education. The outpatient neurology clinic allocates 14 appointments per week for urgent TIA referrals to a vascular neurologist. Radiology and cardiology have availability for urgent MRIs and echocardiograms. Comprehensive staff training has ensured effective implementation of the new TIA care model.
Results: The TIA clinic has been successful in decreasing TIA admissions by 57% in the first 2 years of implementation, resulting in increased inpatient bed availability and patient satisfaction.
Conclusion: Due to the successful implementation of this service, it was expanded to other system hospitals with less access to specialized neurological care. The organization aims to implement this care model across multiple service lines.