Stroke and emergency department re-presentation after outpatient TIA management: An interrupted time series study.

Humans Ischemic Attack, Transient / diagnosis Interrupted Time Series Analysis Outpatients Australia / epidemiology Stroke / diagnosis Emergency Service, Hospital
Costs Emergency department Re-presentation Stroke Telemedicine Transient ischaemic attack

Journal

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633

Informations de publication

Date de publication:
Jan 2023
Historique:
received: 03 06 2022
revised: 24 10 2022
accepted: 15 11 2022
pubmed: 26 11 2022
medline: 11 1 2023
entrez: 25 11 2022
Statut: ppublish

Résumé

To assess the effects of a non-admitted management pathway following emergency department (ED) presentation with suspected TIA on: 90-day stroke and ED re-presentations, overnight admission, length of stay (LOS) and costs. We implemented a management pathway across an Australian regional health service (4 hospitals; 2 rural, 10,000 km There were 2031 presentations: 1,467 before, 564 after implementation. Against background declining trends, overnight admissions decreased by 12.4% (95%CI 5.0, 19.7) and total LOS decreased 6 hours (95%CI 1.5, 10.4). Hospital costs reduced by AUD683 per patient with implementation. Outpatient review occurred for 36% at median 5 days (IQR 3, 9), including 19/87 (22%) telemedicine reviews. Pathway adherence was incomplete: 29% had no specialist review. Recurrent stroke increased by 1.3/100 presentations (95%CI 0.6, 2.1) with implementation, then returned to baseline of 0.9/100. ED re-presentations rose at a significant rate after implementation (extra 1.69/100 patients re-presenting/quarter; 95%CI 0.8, 2.6) reaching 32/100. An ED TIA management pathway designed to avoid hospital admission resulted in decreased hospital use and costs; but an initial increase in recurrent stroke and sustained rise in ED re-presentation, possibly related to delayed and incomplete follow-up.

Identifiants

DOI: 10.1016/j.jstrokecerebrovasdis.2022.106900 PMID: 36427470
pubmed: 36427470
pii: S1052-3057(22)00592-4
doi: 10.1016/j.jstrokecerebrovasdis.2022.106900
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

106900

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest All authors report no potential conflicts of interests regarding research, authorship and/or publication of this article.

Auteurs

Rohan S Grimley (RS)

Sunshine Coast University Hospital, Birtinya, Queensland, Australia; Griffith University, School of Medicine, Birtinya, Australia; Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. Electronic address: Rohan.Grimley@health.qld.gov.au.

Taya Collyer (T)

Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia. Electronic address: Taya.Collyer@monash.edu.

Helen M Dewey (HM)

Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Box Hill, Australia. Electronic address: Helen.Dewey@easternhealth.org.au.

Nadine Andrew (N)

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia. Electronic address: Nadine.andrew@monash.edu.

Dominique A Cadilhac (DA)

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Vic, Australia. Electronic address: Dominique.Cadilhac@monash.edu.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Stroke and emergency department...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Accident ischémique transitoire › Stroke and emergency department...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Analyse de série chronologique interrompue › Stroke and emergency department...
questionsmedicales.fr › Personnes › Patients › Patients en consultation externe › Stroke and emergency department...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Stroke and emergency department...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Stroke and emergency department...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Stroke and emergency department...