The Development and Performance of a Rapid-Access Neurovascular (TIA) Assessment Clinic in a Rural Hospital Setting

Abstract

Following the withdrawal of acute medical services from rural Angus, a rapid-access Neurovascular (TIA) Clinic was established at Stracathro Hospital in December 2003. Referral protocols were agreed with Angus Primary Care. We measured the performance of this clinic over its first two years against national standards outlined by Quality Improvement Scotland (2005). In a retrospective study between 1st December 2003 and 30th November 2005, patient demographics, waiting times, investigation results, diagnoses, and secondary prevention issues were analysed. Challenges presented by a rural setting were also examined, By November 2005, from a total of 355 patients, 79% were seen within 7 days and 98% within 14 days of clinic referral. Pre-clinic bloods were increasingly done in general practice. All patients had CT head and carotid NIVA scans performed on the day of clinic attendance. A high positive diagnostic yield from CT scanning was obtained in the first year of the clinic, and a significant proportion of patients had new secondary drug prevention treatment recommended. Organisational and transport difficulties were addressed and overcome. Developing a rapid-access neurovascular clinic in a rural setting is achievable, and waiting times approaching national standard targets are possible. A TIA clinic can identify rapidly those with cerebrovascular disease, allowing commencement of appropriate secondary prevention therapy.