Reducing time-to-unit among patients referred to an outpatient stroke assessment unit with a novel triage process: a prospective cohort study

• Published in: BMC health services research Vol. 18; no. 1; p. 142
• Main Authors: Bibok, Maximilian B, Votova, Kristine, Balshaw, Robert F, Lesperance, Mary L, Croteau, Nicole S, Trivedi, Anurag, Morrison, Jaclyn, Sedgwick, Colin, Penn, Andrew M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27-02-2018; BioMed Central; BMC
• Subjects: Acute cerebrovascular syndrome; ACVS; Aged; Aged, 80 and over; Ambulatory Care - organization & administration; Canada - epidemiology; Care and treatment; Clinical decision making; Clinical practice guidelines; Clinical prediction rule; Cohort analysis; Decision making; Emergency medical services; Evaluation; Female; Health services; Health Services Research; Humans; Ischemia; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - therapy; Male; Medical referrals; Methods; Middle Aged; Nurses; Patients; Prospective Studies; Quality management; Referral and Consultation; Stroke; Stroke - diagnosis; Stroke - therapy; Survival Analysis; TIA; TIA unit triage; Time-to-Treatment - statistics & numerical data; Transient ischemic attack; Triage (Medicine); Triage - organization & administration; Canada; United Kingdom > UK; ACVS; TIA referral; Transient ischemic attack; Clinical prediction rule; Acute cerebrovascular syndrome; TIA unit triage; TIA
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-2952-x

To evaluate the performance of a novel triage system for Transient Ischemic Attack (TIA) units built upon an existent clinical prediction rule (CPR) to reduce time to unit arrival, relative to the time of symptom onset, for true TIA and minor stroke patients. Differentiating between true and false TIA/minor stroke cases (mimics) is necessary for effective triage as medical intervention for true TIA/minor stroke is time-sensitive and TIA unit spots are a finite resource.
Prospective cohort study design utilizing patient referral data and TIA unit arrival times from a regional fast-track TIA unit on Vancouver Island, Canada, accepting referrals from emergency departments (ED) and general practice (GP). Historical referral cohort (N = 2942) from May 2013-Oct 2014 was triaged using the ABCD2 score; prospective referral cohort (N = 2929) from Nov 2014-Apr 2016 was triaged using the novel system. A retrospective survival curve analysis, censored at 28 days to unit arrival, was used to compare days to unit arrival from event date between cohort patients matched by low (0-3), moderate (4-5) and high (6-7) ABCD2 scores.
Survival curve analysis indicated that using the novel triage system, prospectively referred TIA/minor stroke patients with low and moderate ABCD2 scores arrived at the unit 2 and 1 day earlier than matched historical patients, respectively.
The novel triage process is associated with a reduction in time to unit arrival from symptom onset for referred true TIA/minor stroke patients with low and moderate ABCD2 scores.