Abstract Body: Introduction
The initial 1-3 months following a Transient Ischemic Attack (TIA) or acute stroke are critical for patient management and recovery. Timely follow-up care is recommended to reduce the risk of recurrent stroke and address ongoing health issues. Prolonged hospital stays can hinder prompt outpatient follow-up. We present a pilot model of secured slots for urgent stroke referrals and follow-up for TIA and acute stroke patients.

Methods
A three-year pilot study was conducted within the Geisinger Medical Center Vascular Neurology and Stroke Clinic from October 2021 to June 2024. Dedicated 3:00 PM time slots were established for urgent referrals and follow-ups of patients with TIA and acute stroke from the Emergency Department(ED). Three neurology physicians shared these slots. The study evaluated slot utilization, including time from discharge to clinic visit, 90-day unplanned stroke readmission rates, and the percentage of inappropriate slot use. An integrated assessment was performed to determine the program's impact on clinic workflow and patient outcomes.

Result
An initial review of the first 200 patients revealed the following utilization of secured slots: 21.5% for urgent referrals, 22% for ED follow-ups, 20.5% at provider discretion, 15% allocated by triage team decision, and 18.5% for routine follow-ups. No-shows and scheduling errors accounted for 2.5% of the slots. For urgent referrals and ED follow-ups, there were no unplanned hospital admissions within 90 days. The time to clinic visits after ED discharge ranged from 1 to 21 days (mean 6.9 days), compared to the national average of 2-8 weeks. Many patients underwent partial stroke workups in the ED or hospital. Outpatient testing such as TTE, and ambulatory rhythm monitoring were coordinated to reduce hospital stays. Limitations included challenges in scheduling appointments within 24-72 hours due to provider availability, weekends, and patient scheduling conflicts.

Conclusion
Secured stroke clinic slots provide a timely opportunity for high-risk patients to receive immediate follow-up care after ED visits for stroke or TIA. This model significantly reduces hospital costs and improves patient readmission rates, and burden of prolonged hospital stays, without compromising care. Future studies are encouraged to focus on streamlining referrals, reducing scheduling errors, and integrating this model with other stroke-related services, such as rehabilitation to further enhance overall patient care.