Implementation of a rapid, protocol based TIA management pathway
Autor: | Lee H. Schwamm, David F.M. Brown, Susann J. Jarhult, Mary P. Amatangelo, Melissa L. Howell, Isabelle Barnaure-Nachbar, Benjamin A. White, Aneesh B. Singhal, Scott B. Silverman, Joshua N. Goldstein, Yuchiao Chang |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_specialty Neurology Neurologi medicine.medical_treatment lcsh:Medicine Neuroimaging Tertiary care 03 medical and health sciences 0302 clinical medicine length of stay Clinical Protocols Internal medicine medicine Humans cardiovascular diseases Transient ischemic attack Stroke Original Research Aged medicine.diagnostic_test business.industry lcsh:R TIA Emergency Medicine Pathway lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine Admission rate General Medicine Emergency department lcsh:RC86-88.9 Length of Stay medicine.disease stroke Ischemic Attack Transient emergencies Angiography Emergency Medicine Female Cardiac monitoring business Emergency Service Hospital 030217 neurology & neurosurgery Cohort study Neuroscience |
Zdroj: | Western Journal of Emergency Medicine Western Journal of Emergency Medicine, Vol 19, Iss 2 (2018) Jarhult, Susann J.; Howell, Melissa L.; Barnaure-Nachbar, Isabelle; Chang, Yuchiao; White, Benjamin A.; Amatangelo, Mary; et al.(2018). Implementation of a Rapid, Protocol-based TIA Management Pathway. Western Journal of Emergency Medicine, 19(2). doi: 10.5811/westjem.2017.9.35341. Retrieved from: http://www.escholarship.org/uc/item/0cq365s9 |
Popis: | Introduction: Our goal was to assess whether use of a standardized clinical protocol improves efficiency for patients who present to the emergency department (ED) with symptoms of transient ischemic attack (TIA). Methods: We performed a structured, retrospective, cohort study at a large, urban, tertiary care academic center. In July 2012 this hospital implemented a standardized protocol for patients with suspected TIA. The protocol selected high-risk patients for admission and low/intermediate-risk patients to an ED observation unit for workup. Recommended workup included brain imaging, vascular imaging, cardiac monitoring, and observation. Patients were included if clinical providers determined the need for workup for TIA. We included consecutive patients presenting during a six-month period prior to protocol implementation, and those presenting between 6-12 months after implementation. Outcomes included ED length of stay (LOS), hospital LOS, use of neuroimaging, and 90-day risk of stroke or TIA. Results: From 01/2012 to 06/2012, 130 patients were evaluated for TIA symptoms in the ED, and from 01/2013 to 06/2013, 150 patients. The final diagnosis was TIA or stroke in 45% before vs. 41% after (p=0.18). Following the intervention, the inpatient admission rate decreased from 62% to 24% (p |
Databáze: | OpenAIRE |
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