175 Navigating the transient ischaemic attack pathway—unveiling the gaps and developing a standard solution

Abstract

Abstract Background Hyperacute management of a Transient Ischemic Attack (TIA) is necessary to decrease subsequent stroke. We examined our current management of TIA patients to inform a quality improvement initiative to bring our practice in line with the 2023 UK and Ireland Clinical Guidelines for Stroke. Methods We completed a retrospective cohort study of patients who attended our hospital between December 1st 2022 and February 28th 2023. Patients with a primary diagnosis of TIA were identified though the Hospital In-Patient Enquiry (HIPE). Each diagnosis was verified with electronic records review, with exploration of key investigations and management parameters. Results 41 patients were coded as TIA from HIPE. 39 were a verified TIA diagnosis, with a mean age of 68.7 years. 10.2% were seen by direct GP referral to the Acute Medical Unit (AMU), with the rest attending ED initially. The median length of Stay (LoS) in hospital was 2.75 days. Most patients were admitted under the AMU (33%) or Stroke service (26%), with a shorter LoS if the patient was admitted under these services. 38 patients underwent neuroimaging; 94.8% CT Brain, 84.6% MRI Brain, and 82.1% both CT and MRI imaging. 1 patient went directly for MRI Brain without CT imaging. 82.1% were reviewed by a stroke specialist. Dual Anti-Platelet Therapy (DAPT) was used in 3 patients, single antiplatelet in 21, and oral anticoagulation in 9. 3 patients were discharged without any anti-thrombotic therapy. Conclusion This study highlights areas for improvement in the management of TIA in our facility. Our results have informed the development of a new TIA pathway, which will encourage an ambulatory approach to investigations and management of patients with a TIA. Improved patient-centred outcomes may include improved selection for DAPT, improved neuroimaging efficiency with increased direct to MRI imaging and higher numbers of patients being reviewed by a stroke specialist clinician.