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RISK OF EMERGENCY DEPARTMENT RE-PRESENTATION FOLLOWING INTRODUCTION OF AMBULANT CARE FOR SUSPECTED TIA.
Abstract
Background and Aims
Urgent ambulant care is recommended following suspected TIA, but unintended consequences including ED re-presentations are poorly investigated. We aimed to assess the effects of an ambulatory care pathway following emergency department (ED) TIA presentation on 90-day stroke and ED re-presentations.
Methods
Hospital administrative datasets were linked across the Sunshine Coast Health Service (Queensland, Australia. 4 hospitals [2 rural], 10,000 km2), 5 years before (control) and 2 years after (intervention) a censored six-month implementation phase (2015). Interrupted time series analysis was used to assess the effects on outcomes.
Results
Included were 2020 presentations with an ED TIA diagnosis (1476 control, 564 intervention). In the control phase 58% were admitted. In the intervention phase, 71% were either admitted (35%) or received ambulant review (36%, at median 5days; IQR 3, 9). Initially 21% of patients re-presented within 90 days. An increasing trend in re-presentation became significant in the intervention phase with 1.5 more patients re-presenting/100/quarter than control phase (95%CI 0.8, 2.6); reaching 32% at study end. One third of re-presentations were stroke/TIA related in both study periods; occurring earlier in the intervention (2days IQR 1, 2) than control period (5days IQR 1, 5). Recurrent stroke declined non-significantly from 0.9/100 presentations in control period, rose by 1.3/100 (95%CI 0.6, 2.1) in the first intervention quarter, then declined to 0.9/100 by study end.
Conclusions
Increased ED representation may be an unintended consequence of ambulant care models. Ensuring complete and early follow up is essential in providing safe and effective ambulant TIA care.