Expedited and Comprehensive Management of Low-Risk TIA Patients in the Emergency Department is Safe and Less Costly

Autor: Anisha Garg, Ilavarasy Maran, Hardik Amin, Melissa Davis, Kelsey Vlieks, Richa Sharma, Ajay Malhotra, Kaile Neuschatz, Adam Jasne, Kelly Poskus, Lauren H Sansing, Anna Coppola, Frank Minja, Jennifer Johnson, Joseph Schindler
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Time Factors
Cost-Benefit Analysis
Risk Assessment
Decision Support Techniques
Clinical Protocols
Cost Savings
Predictive Value of Tests
Risk Factors
parasitic diseases
medicine
ABCD2
Humans
cardiovascular diseases
Hospital Costs
Stroke
Aged
Retrospective Studies
Aged
80 and over
biology
Delivery of Health Care
Integrated
business.industry
Rehabilitation
Emergency department
Length of Stay
Middle Aged
medicine.disease
nervous system diseases
Cost savings
Patient management
Clinical Practice
Outcome and Process Assessment
Health Care
Treatment Outcome
Ischemic Attack
Transient
Emergency medicine
Cohort
biology.protein
Feasibility Studies
Female
Surgery
Neurology (clinical)
Triage
Emergency Service
Hospital
Cardiology and Cardiovascular Medicine
business
Cohort study
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 30:106016
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106016
Popis: Transient ischemic attack (TIA) can be a warning sign of an impending stroke. The objective of our study is to assess the feasibility, safety, and cost savings of a comprehensive TIA protocol in the emergency room for low-risk TIA patients.This is a retrospective, single-center cohort study performed at an academic comprehensive stroke center. We implemented an emergency department-based TIA protocol pathway for low-risk TIA patients (defined as ABCD2 score4 and without significant vessel stenosis) who were able to undergo vascular imaging and a brain MRI in the emergency room. Patients were set up with rapid outpatient follow-up in our stroke clinic and scheduled for an outpatient echocardiogram, if indicated. We compared this cohort to TIA patients admitted prior to the implementation of the TIA protocol who would have qualified. Outcomes of interest included length of stay, hospital cost, radiographic and echocardiogram findings, recurrent neurovascular events within 30 days, and final diagnosis.A total of 138 patients were assessed (65 patients in the pre-pathway cohort, 73 in the expedited, post-TIA pathway implementation cohort). Average time from MRI order to MRI end was 6.4 h compared to 2.3 h in the pre- and post-pathway cohorts, respectively (p 0.0001). The average length of stay for the pre-pathway group was 28.8 h in the pre-pathway cohort compared to 7.7 h in the post-pathway cohort (p 0.0001). There were no differences in neuroimaging or echocardiographic findings. There were no differences in the 30 days re-presentation for stroke or TIA or mortality between the two groups. The direct cost per TIA admission was $2,944.50 compared to $1,610.50 for TIA patients triaged through the pathway at our institution.This study demonstrates the feasibility, safety, and cost-savings of a comprehensive, emergency department-based TIA protocol. Further study is needed to confirm overall benefit of an expedited approach to TIA patient management and guide clinical practice recommendations.
Databáze: OpenAIRE
Externí odkaz: