From Inpatient to Ambulatory Care: The Introduction of a Rapid Access Transient Ischaemic Attack Service

Background: Transient Ischaemic Attacks (TIA) should be treated as a medical emergency. While high-risk TIAs have higher stroke risks than low-risk patients, there is an inherent limitation to this risk stratification, as some low-risk patients may have undiagnosed high-risk conditions. Inequity of care for TIA patients was observed, such that high-risk patients received urgent assessment through acute admission, while low-risk patients faced long waits for clinical consultation. A redesign of the TIA service was planned to offer timely assessment for all patients and avoid acute admission for high-risk patients. Methods: Service reconfiguration was undertaken to set up a daily weekday rapid access TIA clinic where patients would be assessed, investigated, and treated. Results: A re-audit of clinic performance showed a significant increase in the number of patients seen in the ages of 18 to 52. The median time from referral to clinical consultation improved from 10 days to 1. There were similar significant improvements seen in median time to brain imaging (from 10.5 days to 1), and carotid ultrasound (from 10 days to all scans being performed on the same day). Conclusions: The redesigned service achieved the objective of offering urgent assessment and investigations for all TIA patients, including low-risk patients, while avoiding the acute admission for high-risk patients. We share our experience of establishing a successful rapid access ambulatory service without any additional resources.