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
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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