Abstract WP371: A Transient Ischemic Attack Electronic Decision Support Tool Can Safely Reduce Management Delays
INTRODUCTION: Management of transient ischemic attacks (TIAs) via rapid access specialist TIA services reduces stroke risk. Providing sufficiently rapid specialist input is challenging in some areas and resultant management delays are often unavoidable. In 2009 an electronic decision support (EDS) tool was launched in a New Zealand provincial district to help improve general practitioner (GP) diagnostic accuracy and if deemed appropriate encourage GPs to initiate best medical therapy and diagnostic work-up at first point of contact rather than awaiting specialist review.
HYPOTHESIS: We assessed the hypothesis that TIA EDS in the primary care setting can safely reduce delays in TIA management.
Methods: Patient records of those referred to the hospital TIA service from January through June 2011 were reviewed comparing patients who were referred by GPs using TIA EDS with those referred not using EDS (‘control’).
RESULTS: During the study period a total of 69 patients were referred to the outpatient TIA clinic with 41 (59%) referrals coming from GPs. Overall GPs utilized EDS in the management of 43 patients, 22 (51%) of which resulted in specialist referral. Best medical therapy was in place sooner in the EDS than the control group (2.63 ± 1.12 vs 7.77 ±1.66 days; p<0.05) and a larger proportion of the EDS group had best medical therapy in place within 24 hours (77% vs 70%; p <0.001). Outpatient diagnostic work-up including brain and carotid imaging was completed sooner in the EDS group compared with controls (19.53 ± 2.85 vs 32.33 ± 5.76 days, p=0.05). Careful screening of hospital and primary care records did not identify any adverse events relating to EDS use.
CONCLUSION: In the setting of limited access to rapid specialist TIA services TIA EDS can safely assist GPs in initiating best medical management and diagnostic work-up in the primary care setting resulting in timelier management. However, the observational and retrospective design of this study dictate cautious interpretation and a randomized controlled trial (FASTEST Trial ACTRN12611000792921) to more conclusively assess TIA EDS efficacy, safety, and cost-effectiveness is currently ongoing.
- © 2012 by American Heart Association, Inc.