Short-stay Admission Research Articles

Investigating short-stay admission to a neonatal intensive care unit as a risk factor for reduced breast feeding at discharge in infants ≥36 weeks’ gestation: a retrospective cohort study

ObjectiveThis study aims to determine the effect of infant–mother separation following a short-stay (≤72 hours) admission to a Level 5 neonatal unit versus no admission on infant-feeding outcomes at hospital...

Impact of Tele-Triage Pathways on Short-Stay Admission after Transfer to a Regional Burn Center for Acute Burn Injury.

Regionalized care for burn-injured patients requires accurate triage. In 2016, we implemented a tele-triage system for acute burn consultations. We evaluated resource utilization following implementation, hypothesizing that this system would reduce short-stay admissions and prioritize inpatient care for those with higher burn severity. We conducted a retrospective study of all transferred patients with acute burn injuries from January 1, 2010 to December 31, 2015, and January 1, 2017 to December 31, 2019. We evaluated the proportions of short-stay admissions (discharges less than 24 hours without operative intervention, ICU admission, or concern for nonaccidental trauma) among patients transferred before (2010 to 2015) and after (2017 to 2019) triage system implementation. Multivariable Poisson regression was used to evaluate factors associated with short-stay admissions. Interrupted time series analysis was used to evaluate the effect of the triage system. There were 4,688 burn transfers (3,244 preimplementation and 1,444 postimplementation) in the study periods. Mean age was higher postimplementation (32 vs 29 years, p < 0.001). Median hospital length of stay (LOS) and ICU LOS were both 1 day higher, more patients underwent operative intervention (19% vs 16%), and median time to first operation was 1 day lower postimplementation. Short-stay admissions decreased from 50% (n = 1,624) to 39% (n = 561), and patients were 17% less likely to have a short-stay admission after implementation (adjusted relative risk [aRR], 0.83; 95% CI, 0.8 to 0.9). Pediatric patients younger than 15 years old composed 43% of all short-stay admissions and were much more likely than adult patients to have a short-stay admission independent of transfer timing (aRR, 2.36; 95% CI, 1.84 to 3.03). Tele-triage burn transfer center protocols reduced short-stay admissions and prioritized inpatient care for patients with more severe injuries. Pediatric patients remain more likely to have short-stay admission after transfer.

Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews

ObjectivesThe aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland.DesignExploratory sequential mixed-methods study. Routinely...

MP53-18 ERAS IMPROVES OUTCOMES FOR EXTENDED RECOVERY SURGERIES IN PEDIATRIC NON-RECONSTRUCTIVE POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP53-18 ERAS IMPROVES OUTCOMES FOR EXTENDED RECOVERY SURGERIES IN PEDIATRIC NON-RECONSTRUCTIVE POPULATION Kristen M. Meier, Carter J. Sevick, Jennifer Pyrzanowski, Vijaya M. Vemulakonda, Jeffrey B. Campbell, Duncan T. Wilcox, Nicholas G. Cost, Brian T. Caldwell, Megan A. Brockel, and Kyle O. Rove Kristen M. MeierKristen M. Meier More articles by this author , Carter J. SevickCarter J. Sevick More articles by this author , Jennifer PyrzanowskiJennifer Pyrzanowski More articles by this author , Vijaya M. VemulakondaVijaya M. Vemulakonda More articles by this author , Jeffrey B. CampbellJeffrey B. Campbell More articles by this author , Duncan T. WilcoxDuncan T. Wilcox More articles by this author , Nicholas G. CostNicholas G. Cost More articles by this author , Brian T. CaldwellBrian T. Caldwell More articles by this author , Megan A. BrockelMegan A. Brockel More articles by this author , and Kyle O. RoveKyle O. Rove More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Enhanced Recovery After Surgery (ERAS) is a set of perioperative strategies to improve surgical recovery. Though it has gained traction in adults, it has been less studied in pediatrics. A standardized ERAS protocol for complex lower urinary tract reconstructive surgeries was introduced in 2014 at our institution. ERAS was expanded to all urologic surgeries requiring an inpatient admission (e.g., extended recovery) in 2018. We hypothesized that patients receiving care under ERAS would have fewer complications than recent historical controls. METHODS: In fall 2018, stakeholder consensus was sought to create an ERAS protocol for ureteral operations, pyeloplasty, non-oncologic nephrectomy, and urachal excisions. Input from urology, anesthesia, and nursing was sought. Patients from a single center were retrospectively reviewed from an IRB-approved database including patients who received ERAS protocol (2018–2022) and recent historical controls (2016–2018). Twenty ERAS measures were included in the protocol and tracked for each patient. Outcomes were 30-day complications, protocol adherence, length of stay (LOS), opioid requirements, and unexpected healthcare encounters (ED visits, re-admissions, reoperations) within 30 days. RESULTS: 131 patients were included (60 historical and 71 ERAS). Patients were demographically similar, though the historical group had a higher percentage of comorbidities (6.7% of controls had kidney transplant history vs 0% in ERAS, p<0.05). Adherence to protocol measures was improved in the ERAS group (14 [13–15] vs 12 [11–13], p<0.001). Individual process measure compliance is illustrated in Table 1. LOS, maximum PACU pain scores, and opioid prescriptions decreased in the ERAS group (1.2 days [1.1–1.3] vs 1.3 days [1.2–2.2], p<0.001; 4 [0–6] vs 0 [0–3], p<0.05; and 39% vs 80%, p<0.001, respectively). There was no difference in unscheduled healthcare encounters, though the ERAS group did have a lower 30-day complication rate (0.2 vs 0.5 complications per patient, p<0.006). Most complications for both groups were Clavien-Dindo grade 1. CONCLUSIONS: ERAS improves outcomes across multiple measures in pediatric patients undergoing common urologic surgeries that typically involve in a short-stay admission. These findings should be corroborated on a larger scale. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e719 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristen M. Meier More articles by this author Carter J. Sevick More articles by this author Jennifer Pyrzanowski More articles by this author Vijaya M. Vemulakonda More articles by this author Jeffrey B. Campbell More articles by this author Duncan T. Wilcox More articles by this author Nicholas G. Cost More articles by this author Brian T. Caldwell More articles by this author Megan A. Brockel More articles by this author Kyle O. Rove More articles by this author Expand All Advertisement PDF downloadLoading ...

Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes

Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.

Insights from and limitations of data linkage studies: analysis of short-stay urgent admission referral source from routinely collected Scottish data

IntroductionThis study identified the referral source for urgent short-stay admissions (SSAs) and compared characteristics of children with SSA stratified by different referral sources.MethodsRoutinely acquired data from urgent admissions to Scottish...

Trajectory of Pain, Functional Limitation, and Parental Coping Resources Following Pediatric Short-stay Surgery: Factors Impacting Rate of Recovery.

Although there are many benefits of short-stay hospital admissions for high volume, pediatric surgical procedures, this model of care places greater responsibility on parents for the management of children's pain. This study aimed to document the trajectory of child pain outcomes and a range of parent-reported functional outcomes following discharge from a short-stay surgical admission. Moreover, we aimed to document the trajectory of parental perceived personal coping resources. Second, we assessed whether parental dispositional factors, assessed before hospital discharge, predicted the child's pain intensity and parent-reported functional recovery. Participants included children (aged 4 to 14 y) admitted for a short-stay tonsillectomy or appendectomy, and their parents. Parents completed a questionnaire before discharge from hospital. Demographic and surgical information was recorded from medical records. Following discharge, daily assessments of pain and functioning were carried out over a 10-day period using iPods or mobile phones. Predischarge and postdischarge data were obtained for 55 child and parent dyads. Pain intensity scores returned to low levels (2/10 or less) by day 5 for appendectomy and day 10 for tonsillectomy. Parents' perceived personal coping resources increased more slowly following tonsillectomy than appendectomy. Controlling for time since surgery and parental coping resources, parental pain-related catastrophizing was a significant predictor of child pain and functional recovery. Short-stay surgery results in parents facing considerable burden in managing their child's pain and functional impairment over a 10-day period. The potential value of screening for parental pain-related catastrophizing before discharge from hospital warrants further consideration and may enable identification of children likely to experience poorer recovery.

Duration of hospital admission in severe mental illness: is longer better?

SUMMARYA Cochrane review has compared short-stay hospital admission with long-stay/standard admission of patients with severe mental illness for a number of outcomes in a total 2030 participants from 6 randomised trials. It reached the conclusion, supported by limited evidence, that short admissions in mental health units do not increase the risk of death, readmission or worsening of mental state, and pose less risk of delayed discharge and patient's unemployment. This commentary examines the available evidence from previous studies and discusses its relevance to current practice.

Substituting emergency services: primary care vs. hospital care

Overcrowding in emergency departments (EDs) is inefficient, especially if it is caused by inappropriate visits for which primary care physicians could be equally effective as a hospital ED. Our paper investigates the extent to which both ambulatory ED visits and inpatient ED admissions are substitutes for primary care emergency services (PCES) in Germany. We use extensive longitudinal data and fixed effects models. Moreover, we add interaction terms to investigate the influence of various determinants on the strength of the substitution. Our results show significant substitution between PCES and ambulatory ED visits. Regarding the determinants, we find the largest substitution for younger patients. The more accessible the hospital ED is, the significantly larger the substitution. Moreover, substitution is larger among better-educated patients. For inpatient ED admission, we find significant substitution that is eight times smaller than the substitution for ambulatory ED visits. With regard to the determinants, we find the strongest substitution for non-urgent, short-stay admission and elderly patients. Countries with no gate-keeping system (such as Germany) have difficulties redirecting the patients streaming to EDs. Our estimated elasticities can help policy makers to resolve this issue, as our findings indicate where incentivizing the utilization of PCES is particularly effective.

Utility of community-acquired pneumonia severity scores in guiding disposition from the emergency department: Intensive care or short-stay unit?

To assess community-acquired pneumonia severity scores from two perspectives: (i) prediction of ICU admission or mortality; and (ii) utility of low scores for prediction of discharge within 48 h, potentially indicating suitability for short-stay unit admission. Patients with community-acquired pneumonia were identified from a prospective database of emergency patients admitted with infection. Pneumonia severity index (PSI), CURB-65, CORB, CURXO, SMARTCOP scores and the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) minor criteria were calculated. Diagnostic accuracy statistics (sensitivity, specificity, predictive values, likelihood ratios and area under receiver operating characteristic curves [AUROC]) were determined for both end-points. Of 618 patients admitted with community-acquired pneumonia judged eligible for invasive therapies, 75 (12.1%) were admitted to ICU or deceased at 30 days, and 87 (14.1%) were discharged within 48 h. All scores effectively stratified patients into categories of risk. For prediction of severe pneumonia, SMARTCOP, CURXO and IDSA/ATS discriminated well (AUROC 0.84-0.87). SMARTCOP and CURXO showed optimal sensitivity (85% [95% confidence interval (CI) 75-92]), while specificity was highest for CORB and CURB-65 (93% and 94%, respectively). Using lowest risk categories for prediction of discharge within 48 h, only SMARTCOP and CURXO showed specificity >80%. PSI demonstrated highest positive predictive value (31% [95% CI 24-39]) and AUROC (0.74 [95% CI 0.69-0.79]). Community-acquired pneumonia severity scores had different strengths; SMARTCOP and CURXO were sensitive with potential to rule out severe disease, while the high specificity of CORB and CURB-65 facilitated identification of patients at high risk of requirement for ICU. Low severity scores were not useful to identify patients suitable for admission to short-stay units.

Identifying barriers to admission avoidance in an emergency care pathway

Home ward Ealing was launched in October 2015 by West London Mental Health NHS Trust and partners in order to support the aspiration of health and social care commissioners to maximise opportunities to avoid unnecessary non-elective admissions. Home ward provides sub-acute care for Ealing patients in their own homes or in Magnolia Ward in Clayponds (community) Hospital. After nine months of operation, the overall number of referrals into the service has increased significantly compared with the predecessor service, however numbers of non-elective admissions continued to rise. Communication between the Home ward partnership and the emergency department indicated anecdotal concerns about delays in referrals for patients for whom an admission may have been avoided. A survey was undertaken of forty-four consecutive referrals between 20-30 June 2016 to Home ward from the emergency department to examine whether Home ward intervention was occurring early enough in the acute patient pathway to avoid admission, and to identify other avoidable delays contributing to inefficient care and poor patient experience. Results showed that only a small minority of cases were seen and discharged in under 4 hours, even though two thirds were identified and assessment initiated rapidly in pre-admission areas. 91% of attendances converted to trigger a short stay admission tariff due to patients being transferred to the Clinical Decisions Unit (CDU). Nearly half of patients were admitted to an observation ward before a decision was made to admit or discharge, suggesting potential benefit for including such a facility as part of the admission avoidance pathway. For the intermediate care population: if you reach the hospital, you'll find yourself in a bed. We concluded that opportunities in the ED to avoid conversion to a short-stay admission are limited, with most patients identified as potentially suitable for intermediate care being transferred to CDU before discharge decision was made. Greater emphasis on attendance avoidance (through GP and Ambulance Service liaison) may be more effective at avoiding admissions than work at the front door of the hospital.

Day-case otological surgery

The author reviews day-case otological surgery, which has become increasingly popular in France and all over the world over recent years. Ear surgery is particularly suitable for short-stay admission because of the rapidity of these procedures and possibilities of pain control. This article discusses the advantages of this mode of management (for the patient, the surgeon and the healthcare institution), organizational and safety constraints, and ineligibility criteria. Day-case otological surgery should now become the rule rather than an opportunity.

Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration.

BackgroundTo determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h).MethodsUsing 114,043 observation stays and short-stay admissions for chest pain at Veterans Health Administration hospitals between 2005 and 2013, we estimated event-level logistic regression models using a generalized estimating equation framework to predict 30 and 90-day readmissions and mortality as a function of whether the patient had an observation stay or a short-stay admission. We also adjusted for a variety of patient characteristics and unobserved time-invariant hospital factors.ResultsRelative to the short-stay inpatient group, veterans with chest pain who were placed in observation status were significantly more likely to be female (7.0 % vs. 6.4 %, White (76.6 % vs. 71.0 %, and from a rural area (28.3 % vs. 20.2 %). There were no other meaningful differences between the groups. Veterans with chest pain who were placed in observation status had 25 % lower odds of dying within 30 days (95 % confidence interval [CI]: 3 % – 43 %) and 12 % lower odds of a 30-day readmission (95 % CI: 6 % – 17 %) compared to those admitted as short-stay inpatients. Neither 90-day outcome was significantly associated with placement in observation status. Patient demographics were also important predictors of mortality and readmissions.ConclusionsThere are clinically observable differences in outcomes between patients admitted to observation and those admitted as short-stay inpatients. We find no evidence that the increase in observation stays reflects a lack of proper care for patients placed in observation status.

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions.

We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions. There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission.

Trends in short-stay hospitalizations for older adults from 1990 to 2010: implications for geriatric emergency care

IntroductionGeriatric patients are more likely than younger patients to be admitted to the hospital when they present to the emergency department (ED). Identifying trends in geriatric short-stay admission may inform the development of interventions designed to improve acute care for the elderly. ObjectiveTo evaluate trends in US geriatric short-stay hospitalizations from 1990 to 2010. MethodsRetrospective study using the National Hospital Discharge Survey (NHDS). Trends in short-stay hospitalizations were analyzed from 1990 to 2010 for age groups 22 to 64, 65 to 74, 75 to 84, and at least 85 years using linear regression. ResultsA total of 4.5 million survey visits representing 580 million adult hospitalizations were available for analysis; 250 million (43%) were among patients 65 years or older. Of these, 12%, 25%, and 40% were ≤1, ≤2 and ≤3 days' short-stay admissions, respectively. Between 1990 and 2010, short-stay admissions increased as a percentage of total hospitalizations for each geriatric age group but remained relatively constant for younger adults. Admissions from NHDS were similar to admissions from the ED for years where ED-specific data were available. The older a patient was (age >65 years), the more likely their admission was to have started in the ED. DiscussionFor all elderly patients, short-stay admissions represented a growing proportion of total admissions, regardless of the definition of short stay. These trends were identified despite the NHDS exclusion of observation status hospitalizations. The increase in short-stay admissions was the most pronounced in the extreme elderly (age ≥85 years). Future research is needed to optimize treatment for geriatric patients presenting to the ED, some of whom, with brief observation and appropriate follow-up, may be better cared for without hospitalization.

Deriving a prediction rule for short stay admission in trauma patients admitted at a major trauma centre in Australia

IntroductionThe aim of this study was to derive and internally validate a prediction rule for short stay admissions (SSAs) in trauma patients admitted to a major trauma centre.MethodsA retrospective study...

Making Greater Use Of Dedicated Hospital Observation Units For Many Short-Stay Patients Could Save $3.1 Billion A Year

Using observation units in hospitals to provide care to certain patients can be more efficient than admitting them to the hospital and can result in shorter lengths-of-stay and lower costs. However, such units are present in only about one-third of US hospitals. We estimated national cost savings that would result from increasing the prevalence and use of observation units for patients whose stay there would be shorter than twenty-four hours. Using a systematic literature review, national survey data, and a simulation model, we estimated that if hospitals without observation units had them in place, the average cost savings per patient would be $1,572, annual hospital savings would be $4.6million, and national cost savings would be $3.1billion. Future policies intended to increase the cost-efficiency of hospital care should include support for observation unit care as an alternative to short-stay inpatient admission.

National Study of Emergency Department Observation Services

The objective was to describe patient and facility characteristics of emergency department (ED) observation services in the United States. The authors analyzed the 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Characteristics of EDs with observation units (OUs) were compared to those without, and patients with a disposition of ED observation were compared to those with a "short-stay" (<48 hour) hospital admission. Results are descriptive and without formal statistical comparisons for this observational analysis. An estimated 1,746 U.S. EDs (36%) reported having OUs, of which 56% are administratively managed by ED staff. Fifty-two percent of hospitals with ED-managed OUs are in an urban location, and 89% report ED boarding, compared to 29 and 65% of those that do not have an OU. The admission rate is 38% at those with ED-managed OUs and 15% at those without OUs. Of the 15.1% of all ED patients who are kept in the hospital following an ED visit, one-quarter are kept for either a short-stay admission (1.8%) or an ED observation admission (2.1%). Most (82%) ED observation patients were discharged from the ED. ED observation patients were similar to short-stay admission patients in terms of age (median = 52 years for both, interquartile range = 36 to 70 years), self-pay (12% vs. 10%), ambulance arrival (37% vs. 36%), urgent/emergent triage acuity (77% vs. 74%), use of ≥1 ED medication (64% vs.76%), and the most common primary chief complaints and primary diagnoses. Over one-third of U.S. EDs have an OU. Short-stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs.

Implementation of a short-stay programme after breast cancer surgery

: Short-stay breast cancer surgery (24 h or day case) is not common practice in Europe. This before-after comparative study was carried out to test the feasibility of systematically implementing a care programme incorporating short-stay admission using strategies tailored to individual hospital needs, and to assess safety and facilitating factors. : Patients with breast cancer from four Dutch hospitals participated. The intervention concerned the programme developed by the Maastricht University Medical Centre. This was implemented through local multidisciplinary meetings and educational outreach visits. : Of 421 eligible patients, 324 (77.0 per cent) gave consent to participate. The proportion of patients who had short-stay treatment increased from 45.3 per cent before to 82.2 per cent after implementation of the programme (P < 0.001). No increase was observed in the rate of complications, readmissions, reoperations or number of visits to the emergency department. Factors associated with an increased chance of short-stay treatment were: breast-conserving surgery, having children and being employed. Being aged over 64 years showed a trend towards a decreased chance. : Introducing a care programme incorporating short stay following breast cancer surgery in four hospitals was feasible and safe.

Patients With Transient Ischemic Attack or Minor Stroke Should Be Admitted to Hospital

Transient ischemic attacks (TIAs), like other vascular diseases, whether acute limb ischemia or acute coronary syndromes, are high-risk, unstable conditions. TIA heralds a relatively high risk of stroke, variably estimated to range between 10% and 20% in the ensuing 90 days.1–4 This has been known for several decades.5–8 What is new are reports that show that at least half of the risk of early stroke accrues in the first 2 days after TIA. Necessarily then, any protective strategy needs to be implemented rapidly. It is surprising that for a condition as common and serious as TIA, there remains so much variability in acute management. Whereas in some institutions, TIA patients are admitted routinely, in other jurisdictions, TIA patients are frequently discharged from the emergency department with suboptimal management, and many discharged TIA patients are unlikely to obtain adequate evaluation or treatment on an outpatient basis within 30 days.4 Although the value of inpatient stroke units is well established, little is known about the value of acute observation and investigation units for patients with TIA or minor stroke. Some potential benefits of a short-stay hospital admission include: (1) expedited diagnostic evaluation; (2) monitoring of fluctuating patients with ready access to thrombolysis if they deteriorate; (3) facilitation of early carotid revascularization; and (4) …