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Health services research
Research
Referral pathways for patients with TIA avoiding hospital admission: a scoping review
  1. Bridie Angela Evans1,
  2. Khalid Ali2,
  3. Jenna Bulger1,
  4. Gary A Ford3,
  5. Matthew Jones1,
  6. Chris Moore4,
  7. Alison Porter1,
  8. Alan David Pryce5,
  9. Tom Quinn6,
  10. Anne C Seagrove1,
  11. Helen Snooks1,
  12. Shirley Whitman5,
  13. Nigel Rees4
  14. on behalf of the TIER Trial Research Management Group
  1. 1Swansea University Medical School, Swansea, UK
  2. 2Brighton and Sussex Medical School, Brighton, UK
  3. 3Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4Welsh Ambulance Service NHS Trust, Swansea, UK
  5. 5Lay Contributor c/o Swansea University Medical School, Swansea, UK
  6. 6Kingston University and St George's, University of London, London, UK
  1. Correspondence to Dr Bridie Angela Evans; b.a.evans{at}swansea.ac.uk

Abstract

Objective To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital.

Design Scoping review.

Data sources PubMed, CINAHL Web of Science, Scopus.

Study selection Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services.

Data extraction We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes.

Results 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6–10% predicted rate to 1.3–2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways.

Conclusions Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial.

Trial registration number ISRCTN85516498. Stage: pre-results.

  • Transient Ischaemic Attack
  • Alternative pathways
  • Prehospital emergency care
  • Scoping review

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013443

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    Footnotes

    • Contributors BAE undertook searches, screening, drafted the results and led writing of this paper. MJ undertook searches and screening. BAE and JB extracted data. KA, GAF and TQ provided expertise about management of transient ischaemic attacks. CM and NR provided expertise about management and practice of prehospital services; JB, AP, ACS and HS provided health services research and methodological expertise. ADP and SW provided patient and carer experience and perspectives. All authors contributed to the review. All authors contributed to the paper, read and agreed the final manuscript.

    • Funding This work was supported by Health and Care Research Wales through their Research for Patient and Public Benefit (RfPPB) stream (award number 1053).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.