Abstract TP359: Rapid Access Stroke Unit - A Virtual Clinic to Assess Minor Stroke Admissions, Expedite Investigations and Implement Timely Treatments

Abstract

Background: The current Stroke service is seeing more than 200 patients per month admitted to our acute tertiary hospital. Acute major stroke patients are admitted to the stroke ward but many of the minor strokes or mimics are admitted to an acute medical assessment unit (AMAU) waiting on average 3 days for completion of investigations. TIA clinics are an established element of a stroke service in other countries. We established a similar service, the Rapid Access Stroke Unit (RASU), opened daily in July 2018 aiming to reduce admission rates by expediting investigations and treatments for patients presenting with minor or resolved symptoms. The referral criteria for RASU is a CT scan with no evidence of hyperacute stroke and the Patient is independent in ADL’s. If the patient is in hospital the clinical nurse specialist will triage patients for suitability for transfer to RASU. Out of hours suitable patients can be discharged from ED with instructions to attend RASU the following morning. The clinical nurse specialist, supported by the Stroke Consultant, will coordinate the investigations, track results, organise reviews and ensure the patients are fully educated of diagnosis, treatment and risk factor management. Results: The first year’s figures show a decrease in the inpatient admissions with 496 patients attending RASU, saving 1749 bed days. There is also an increase in the number of patients discharged directly home from the Emergency Department (ED), with the option of attending RASU if required. The diagnosis of patients admitted to RASU are 102 ischemic, 145 TIA, 247 Mimics and 1 ICH. Conclusion: One-year results have shown a significant benefit in patient care, early discharge and improved use of the hospital resources. One unexpected result was the increase in discharges from ED and this may be attributed to the ED physicians discharging patients confident that there is a rapid access service available. Another consequence of the service is that patients will ‘walk in’ to RASU if they have any further concerns or require clarification of treatments.