Fnu “Al” Alfandy, DNP, AGACNP-BC, ANP-BC

Abstract:

Background: Unnecessary admissions fuel rising healthcare costs and take away resources from higher acuity patients without evidence of increased safety. Objectives: To determine if the care diversion for transient ischemic attack (TIA), from inpatient to a nurse practitioner (NP)-led specialty clinic, resulted in no increase in stroke incidence at 90 days. Methods: The sample included all adults (18 years or older) presenting to the emergency department (ED) with TIA at low-to-moderate risk for stroke. Risks were defined by the ABCD2 score and non-invasive vessel imaging. Patients who met the criteria were discharged and evaluated by a stroke NP at the TIA clinic within seven days. These patients were compared to those who were admitted to the hospital prior to clinic launch. Chart reviews were conducted to determine stroke incidence at 90 days post TIA. Descriptive statistics were used to evaluate clinical variables, and Fisher’s Exact test was used to assess difference in stroke rates. Patient satisfaction score was collected using the existing institutional survey. Results: Eighty-one participants were included, 40 in the clinic group and 41 in the admission group. The means ages in the clinic group and the admission group were 72.8 and 75.2 years, respectively (p=0.37). Females comprised 45% of patients in the clinic group, compared to 51.2% in the admission group (p=0.58). The mean ABCD2 scores were 4.08 and 3.95 in the clinic and admission groups, respectively (p=0.63). The median clinic follow-up time was 6 days. There was no stroke incidence in the clinic group and one incidence in the admission group (p=1.0) within 90 days of index TIA. Patient satisfaction score with the NP was 92.6%. Conclusion: Referral to a NP-led clinic in patients with low-to-moderate risk TIA was equally safe as hospital admission. 

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