To determine whether a pathway implemented January 1, 2023 to guide management of TIA patients in an academic-affiliated community ED streamlined care via ED length of stay (LOS), likelihood of outpatient neurology follow-up, and time to follow-up. 

TIA represents an opportunity to lower stroke risk if recognized and managed appropriately; however, TIA patients often have prolonged admissions and suboptimal follow-up. Past work shows that implementing a practice structure can reduce LOS and cost for TIA patients in the inpatient setting. Specialty clinic referrals have been shown to reduce neurovascular readmission and mortality.

Records from June 2022 through April 2024 were queried for patients with suspected TIA diagnosis entered into a navigator on admission or listed as discharge diagnosis. Two independent clinicians reviewed records to determine if the diagnosis was appropriate. We compared outcomes  before and after pathway rollout. Data were analyzed using descriptive statistics.

90 consecutive ED patients with TIA were included, 58 of which presented after pathway rollout. Of the 58, 30 documented definite use of the pathway (51.7% adherence). Median (25^th, 75th quartiles) ED LOS before pathway rollout was 575 minutes (347, 1446) versus 639 minutes (484, 1300) thereafter (p=0.582). The percentage of patients reaching clinic follow-up was 34.4% vs. 44.83% (p=0.377). Median time to follow-up was 94 days (26, 124) vs. 65 days (45, 79), (p=0.345).  

Implementation of a TIA management pathway resulted in trends toward increased follow-up and shorter time to follow-up, though not statistically significant. While TIA ED LOS rose over time, there was also a rise in ED for LOS for allcomers, confounding potential detection of  benefit related to pathway implementation. Next steps will focus on incorporating  scheduling of subspecialty follow-up prior to discharge into the pathway, and increasing  adherence. Metrics of efficiency could be compared to ED data for other chief complaints.