Abstract TP330: TIA A Shorter Stay
Background: In the United States, between 200 and 500 thousand Transient Ischemic Attacks (TIAS) are reported yearly, only 50% report symptoms to their physician. Rapid action is of critical importance to reduce risk of brain injury. TIA is a chance for timely lifestyle changes or medical intervention. Momentary signs could precede a potentially fatal stroke or could be a stroke. TIA is recognized as an emergent warning sign of underlying disease. Hospital admission is costly and may be unacceptable to symptom free patients. We developed a rapid work up, CODE TIA, to faciltate patient stays of less than 23 hours.
Method: We reviewed methods to decrease length of stay(LOS), decrease unnecessary tests ordered, treat & educate patients to prevent stroke where appropriate, send them home, treated in a reasonable time frame. We conducted extensive staff education. A CODE TIA sticker was created & placed on the front of TIA patients’ charts to alert staff to the time left until the proposed discharge.TIA order sets were developed and MDs were educated to use them. A TIA checklist for nurses was created to follow patient’s progress & any pending tests. A TIA pathway handout was also created for patients. This visual record enables the patient to participate in their own care and track their progress.The stroke team meets monthly to discuss data & opportunities for improvement. For example, discharge delays occurred while waiting for bubble studies (TEE with echocontrast). We trained & certified all stroke nurses to administer echocontrast.Delays for echocardiography were eliminated.
Results: The LOS was 3.66 days for patients diagnosised with TIA.The data shows that the CODE TIA program is successful. We have decreased the LOS dramatically. Since August, we had 59 patients the TIA pathway. Of these,31(52%) converted to a regular stay if co-morbidities or diagnosis of stroke was discovered. Interestingly, 28 (47%) patients went home in 0.92 days. That is a 74.9% decrease in the patient’s LOS. Patients diagnosed withTIA, not on pathway, had a LOS of 1.6 days.
Conclusion: A directed TIA pathway, with extensive education, order sets, patient materials & aggressive stroke team involvement yielded significant reduction in LOS.Outcome studies needed to assure stroke risk reduction.
- © 2012 by American Heart Association, Inc.