A transient ischemic attack (TIA) is a brief episode of neurological dysfunction typically lasting under 60 minutes. Patients presenting with TIA are at increased risk of recurrent stroke, particularly within the first week following initial event. Health Sciences North (HSN) is a Regional Stroke Centre, located in Sudbury, Canada. In 2016, 161 people presented to ED with presentation of TIA. Managed solely by the ED, the Stroke Program is not involved in the visit. Recent data shows 28% of ED TIA patients are discharged home without a referral to the secondary stroke prevention clinic. When necessary, TIA patients are admitted. HSN’s annual average length of stay (LOS) at HSN in 2016-17 was 4.5 days. The stroke prevention clinic has limited service availability, receiving 375 referrals annually. The average wait time for the clinic, for those at highest risk is 2.7 days. Only 10% are seen in the timely manner set out by Canadian Stroke Best Practice Recommendations. The eight month pilot study TIME began January 1st 2018 whereby the Stroke Program’s Medical Lead physician will respond to all TIA presentations to ED to establish the TIA diagnosis, identify stroke mimics, facilitate best practice work-up, admit when very high risk features warrant, initiate secondary stroke prevention medications, dispense education package and refer to prevention clinic. Our hypothesis is that TIME will have a positive impact on % referrals to clinic at ED discharge; TIA admission rate; TIA inpatient LOS; wait time to clinic. Pilot evaluation will yield early results in October 2018.

TIA MANAGEMENT IN THE ED (TIME): ONE STROKE CENTER'S EFFORTS TO IMPROVE ACCESS TO TIMELY SECONDARY STROKE PREVENTION SERVICES