Abstract T P294: Systematic Implementation of a Multi-Hospital Rapid TIA Evaluation Protocol Reduces Unnecessary Admissions
Intro: Rapid management of TIA patients is a cost-effective intervention to reduce stroke incidence. We evaluated the effect of an ED-based rapid TIA evaluation protocol on the provision of care concordant with a system-wide TIA guideline that was developed in a multi-hospital collaborative QI project.
Method: We included 89 consecutive patients in pre-intervention (2012) and 72 in post-intervention (2013) phases from 2 tertiary and 1 large community hospitals. Patient evaluations and disposition were compared to an evidence-based TIA protocol which determined ED discharge vs. inpatient admission based on imaging results, ability to comply with follow-up, and ABCD2 score (admit if 6-7; outpatient follow-up within 5d if 2-5, or within 7d if 0-1). Univariate and multivariable models explored factors associated with concordant care.
Result: Patient characteristics were comparable in the pre- and postintervention phases (Table 1). Neuro-imaging findings determined disposition more often post-intervention. There was no difference pre vs. post in the recommended disposition to discharge (71.9% vs.73.6%, p 0.86), but the intervention more than doubled the proportion of patients who were actually discharged among those for whom discharge was recommended (22.5% vs. 52.8%, p<0.001). Guideline-concordant care increased significantly from pre-intervention to post (48% to 75%, p=0.001) with all three centers showing improvement (range: Pre 37-62%; Post 68-81%). In univariate analysis, factors associated with concordant care were younger age, medical instability, and post-intervention, while only medical instability [OR 9.95 (CI 1.21 - 82.12) p=0.033] and post-intervention [OR 3.30 (CI 1.64 - 6.65), p=0.001] were independently associated in multivariable analyses.
Conclusion: Implementation of a rapid TIA evaluation protocol increased care concordant with system-wide guidelines, particularly decreasing the percent of patients admitted unnecessarily.
Author Disclosures: K. Bakhadirov: None. A. Razmara: None. S.F. Ali: None. L.B. Hand: None. J.S. Elias: None. S.K. Feske: None. A. Almozlino: None. L.H. Schwamm: Consultant/Advisory Board; Modest; Joint Commission; MA Dept of Public Health. Other; Modest; AHA Get With the Guidelines (unpaid); Coverdell Registry Advisor (unpaid); MGH provides telehealth services under contract to hospitals in northern new england. Employment; Significant; Director, MassGeneral TeleHealth.
- © 2014 by American Heart Association, Inc.