Abstract T P184: Outpatient Evaluation of Transient Ischemic Attack (TIA) Patients
Objectives: We have started an open-access outpatient TIA Rapid Evaluation Center (TREC) at our community medical center. Patients referred to the TREC are seen on the next weekday and undergo a diagnostic evaluation then consultation with a stroke neurologist. The decision to refer a TIA patient to the TREC is left to the discretion of the attending physician.
METHODS: We have collected prospective data from all TREC patients, including follow-up contact at 3 and 12 months to check for future cerebrovascular events. We performed a retrospective chart review on all patients admitted to the hospital with a primary diagnosis of TIA during the same period. This study had IRB approval.
RESULTS: We saw 74 TREC patients within an average of 1.25 days of referral during its first year of operation, 56 from the emergency room and 18 from physician offices. Only 2 TREC patients needed admission to the hospital, the remainder completed their evaluation as out-patients. Only 1 TREC patient had a follow-up cerebrovascular event. During this same time period, 88 patients were admitted to the hospital with a primary diagnosis of TIA. Patients referred to the TREC had lower ABCD2 scores (average of 1.8 vs. 3.8, p <0.001) and were less likely to have a final diagnosis of TIA (19% vs. 77% p<0.001) than the hospitalized patients. More hospitalized TIA patients were seen on weekdays than weekends (74% vs. 27%). Nearly all patients underwent CT scan, lipid panel and EKG. However, TREC patients were more likely to undergo carotid ultrasound (99% vs. 84%, p=0.001) and MRI of the brain (89% vs. 68%, p=0.001). Hospital reimbursement from Medicare is $904 for a TREC patient and $5500 for a TIA hospitalization.
CONCLUSIONS: 40% of all TIA patients at our hospital were referred to the TREC and seen within 1.25 days during its first year of operation. TIA patients referred to the TREC had lower ABCD2 scores and were less likely to have a final diagnosis of TIA. Day of the week seen did not influence the referral decision. TREC patients were more likely to have a complete diagnostic evaluation at a cost savings of $4600 for Medicare patients. Out-patient evaluation of TIA can be an efficient, safe, and less costly alternative to hospital admission.
Author Disclosures: N. Nachimuthu: None. M.E. Chan: None. M.I. Amor: None. A. Puma: None. F. Armour: None. S.S. Hwang: None. N.R. Holland: None.
- © 2014 by American Heart Association, Inc.