OBJECTIVES: To assess the feasibility of implementing an emergency department (ED)-based transient ischemic attack (TIA) clinical pathway that uses computer-based clinical support, and to evaluate measures of quality, safety, and efficiency. METHODS: This was a prospective cohort study of adult patients presenting to a community ED with symptoms consistent with acute TIA. Adherence to the clinical pathway served as a test of feasibility. Compliance with guideline recommendations for antithrombotic therapy and vascular imaging were used as process measures of quality. The 90-day risk of recurrent TIA, stroke, or death provided estimates of safety. Efficiency was assessed by measuring the rate of uneventful hospitalization, defined as a hospital admission that did not result in any major medical event or vascular intervention such as endarterectomy or stent placement. RESULTS: Of the 75 subjects enrolled, physician adherence to the clinical pathway was 85.3%, and 35 patients (46.7%) were discharged home from the ED. Antithrombotic agents were prescribed to 68 (90.7%), and vascular imaging was performed in 70 (93.3%). The 90-day risk of recurrent TIA was seven out of 75 (9.3%; 95% confidence interval [CI] = 4.6% to 18.0%), one patient experienced stroke (1.3%; 95% CI = 0.2% to 7.2%), and three patients died (4.0%; 95% CI = 1.4% to 11.1%). Uneventful hospitalization occurred in 38 of 40 patients (95.0%). CONCLUSIONS: Implementation of a clinical pathway for the evaluation and management of TIA using computer-based clinical support is feasible in a community ED setting. This pilot study in knowledge translation provides a design framework for further studies to assess the safety and efficiency of a structured ED-based TIA clinical pathway.
OBJECTIVES: To assess the feasibility of implementing an emergency department (ED)-based transient ischemic attack (TIA) clinical pathway that uses computer-based clinical support, and to evaluate measures of quality, safety, and efficiency. METHODS: This was a prospective cohort study of adult patients presenting to a community ED with symptoms consistent with acute TIA. Adherence to the clinical pathway served as a test of feasibility. Compliance with guideline recommendations for antithrombotic therapy and vascular imaging were used as process measures of quality. The 90-day risk of recurrent TIA, stroke, or death provided estimates of safety. Efficiency was assessed by measuring the rate of uneventful hospitalization, defined as a hospital admission that did not result in any major medical event or vascular intervention such as endarterectomy or stent placement. RESULTS: Of the 75 subjects enrolled, physician adherence to the clinical pathway was 85.3%, and 35 patients (46.7%) were discharged home from the ED. Antithrombotic agents were prescribed to 68 (90.7%), and vascular imaging was performed in 70 (93.3%). The 90-day risk of recurrent TIA was seven out of 75 (9.3%; 95% confidence interval [CI] = 4.6% to 18.0%), one patient experienced stroke (1.3%; 95% CI = 0.2% to 7.2%), and three patients died (4.0%; 95% CI = 1.4% to 11.1%). Uneventful hospitalization occurred in 38 of 40 patients (95.0%). CONCLUSIONS: Implementation of a clinical pathway for the evaluation and management of TIA using computer-based clinical support is feasible in a community ED setting. This pilot study in knowledge translation provides a design framework for further studies to assess the safety and efficiency of a structured ED-based TIA clinical pathway.
Authors: P H S Kalmet; B B Koc; B Hemmes; R H M Ten Broeke; G Dekkers; P Hustinx; M G Schotanus; P Tilman; H M J Janzing; J M A Verkeyn; P R G Brink; M Poeze Journal: Geriatr Orthop Surg Rehabil Date: 2016-05-02
Authors: Andy Lim; Shaloo Singhal; Philippa Lavallee; Pierre Amarenco; Peter M Rothwell; Gregory Albers; Mukul Sharma; Robert Brown; Annemarei Ranta; Mohana Maddula; Timothy Kleinig; Jesse Dawson; Mitchell S V Elkind; Maria Guarino; Shelagh B Coutts; Benjamin Clissold; Henry Ma; Thanh Phan Journal: J Stroke Cerebrovasc Dis Date: 2020-08-18 Impact factor: 2.136
Authors: Pishtiwan H S Kalmet; Stijn G C J de Joode; Audrey A A Fiddelers; Rene H M Ten Broeke; Martijn Poeze; Taco Blokhuis Journal: Geriatr Orthop Surg Rehabil Date: 2019-06-06
Authors: Raghupathy Anchala; Maria P Pinto; Amir Shroufi; Rajiv Chowdhury; Jean Sanderson; Laura Johnson; Patricia Blanco; Dorairaj Prabhakaran; Oscar H Franco Journal: PLoS One Date: 2012-10-10 Impact factor: 3.240