23 Rapid access stroke prevention clinic, are we adhering to international recommendations?

Abstract

Abstract Background Transient Ischaemic attack (TIA), accounted for over 2000 hospital admissions in Ireland in 2020. 25% of all TIA presentations develop stroke. The European Stroke Organisation (ESO) and National Stroke Strategy have recommended the development of rapid access stroke prevention (RASP) clinics, to reduce morbidity associated with devastating stroke event and reduce unnecessary hospital admissions. This project reviews the functionality of a RASP clinic in an Irish hospital and compares it to international recommendations. Methods A retrospective chart review of patients who had been referred to the clinic over a three month period was performed. The initial referral date, clinic review date, date of any appropriate investigations and final diagnosis were collected and compared against the current recommendations. Quantitative analysis was performed on this data. Results A total of 43 patients were included, 18 were referred by the emergency department (ED), 25 by general practitioners (GP). On average GP referrals were waiting 5.8 days, and ED referrals 3.5 days, to be seen by a specialist. Current ESO recommendation is for specialist review within 24 hours. Of those referred, 34 underwent the recommended carotid imaging. 7 of the 43 were diagnosed with TIA, highlighting the poor sensitivity of the current risk stratification tool (ABCD2). The average time from symptom onset to referral was 3.7. With 15 patients waiting 35 days prior to seeking medical advice. Conclusion It is clear that, at present, the RASP clinic is not meeting the international recommendations. A number of improvements to the referral process have been proposed. The move to an electronic referral process would reduce unnecessary steps in the current pathway and would ensure the appropriate investigations were carried out, at the time of initial contact. Improved patient education on symptoms of TIA is needed. A repeat audit will take place to review if these changes have had a significant impact.