Abstract NS8: Colorado’s First Nurse Facilitated Transient Ischemic Attack Clinic: The New Paradigm for Transient Ischemic Attack Treatment

Abstract

The risk of a disabling stroke after a Transient Ischemic Attack (TIA) is suggested to be highest within the first 48 hours after the TIA event and nearly half of recurrent stroke events ensue within the first 7 days. The TIA Clinic at Porter Adventist Hospital was developed to promote timely, efficient, and comprehensive treatment services for patients, allowing for targeted long term follow-up. Patients presenting with a TIA have limited options for receiving efficient evaluation and follow-up care. They can be admitted to hospitals for further diagnostic testing, seek care at their PCP or attempt to find a neurologist. Unfortunately these options are often expensive and can be the cause of treatment delays. Patients admitted to the hospital often incur higher out of pocket expenses, lost work time and exposure to hospital acquired conditions. The interdisciplinary service provides evaluation of TIA etiology and enables secondary stroke-prevention interventions to be initiated the day of patient’s evaluation. Once diagnostic procedures are completed, the neurologist finalizes the TIA etiology, risk-factor profile, and recommended secondary prevention strategies. Measurement strategies are obtained through patient satisfaction survey at the end of clinic, ninety day phone call follow-up and physician e-mail follow-up. The clinical nurse coordinator collects post-clinic data on this group of patients. After evaluation of 54 patients since the clinics inception there was no recurrence of TIA or stroke symptoms with 90 day follow-up in any patient. In addition, the clinic has proven to provide (1) expedited consultations and diagnosis as available to hospitalized patients; (2) identification and treatment of patients who have actually had a stroke rather than TIA; (3) identification and treatment of “stroke-mimicking” diagnoses such as migraine with aura, seizure, hypoglycemia, arrhythmias, intracerebral hemorrhage and intracranial tumor; and (4) identification of stroke risk factors and rapid implementation of specific interventions in the most vulnerable period for disabling stroke (i.e., the first 2-7 days).