Objective:

Reduction of length of stay (LOS) for transient ischemic attack (TIA) admissions at a public safety net community hospital. 

Background:

Transient focal neurologic deficits are a common chief complaint among patients presenting to Emergency Department (ED). Admitting these patients is costly and increases utilization of limited hospital resources. Thus, the current national trend is to avoid admitting “low risk” TIA patients.  The purpose of this study is to design a “TIA pathway,” in a public safety net hospital setting to expedite evaluation of these patients.

Design/Methods:

We based our TIA pathway protocol on work done by Boyle et al. We tailored our protocol, based on the socioeconomic needs of our patients (27.2% uninsured, 5.2% undomiciled), to further improve access to stroke care for our community.  With ED collaboration, physician training was performed, including utilization of an order set and understanding guidelines for the TIA pathway and inpatient admission.  TIA pathway utilization data and data from admitted TIA patients was gathered from the medical record and AHA Get with the Guidelines registry. In addition, safety data including adverse events, 30 day follow up, readmission, and outcomes were monitored and reviewed monthly by stroke leadership.

Results:

A total of 247 TIA cases were recorded in February 2020 through August 2022. The average LOS of patients admitted to the TIA pathway was 1.58 days, while the average LOS for patients admitted inpatient for TIA workup was 2.92 days. Since the inauguration of TIA pathway, we decreased bed utilization by 130 hospital days.

Conclusions:

A dedicated TIA pathway with well-constructed guidelines, order-sets, and physician education resulted in a significant reduction in hospital LOS for the initial evaluation of TIA patients. Follow up outcome studies will be performed to assess the safety and efficacy of an expedited TIA workup.