Referral pathways for patients with TIA avoiding hospital admission: a scoping review

Evans, Bridie; Ali, Khalid; Bulger, Jenna; Ford, Gary A; Jones, Matthew; Moore, Chris; Porter, Alison; Pryce, Alan David; Quinn, Tom; Seagrove, Anne; Snooks, Helen; Whitman, Shirley; Rees, Nigel

doi:10.1136/bmjopen-2016-013443

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Referral pathways for patients with TIA avoiding hospital admission: a scoping review

Bridie Evans

, Khalid Ali, Jenna Bulger, Gary A Ford, Matthew Jones, Chris Moore, Alison Porter

, Alan David Pryce, Tom Quinn, Anne Seagrove, Helen Snooks

, Shirley Whitman, Nigel Rees

BMJ Open, Volume: 7, Issue: 2, Start page: e013443

Swansea University Authors: Bridie Evans , Matthew Jones, Alison Porter , Anne Seagrove, Helen Snooks

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DOI (Published version): 10.1136/bmjopen-2016-013443

Abstract

AbstractObjective 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 Repor...

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Published in:	BMJ Open
ISSN:	2044-6055 2044-6055
Published:	BMJ 2017
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URI:	https://cronfa.swan.ac.uk/Record/cronfa63477
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first_indexed	2023-05-30T13:06:06Z
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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.</abstract><type>Journal Article</type><journal>BMJ Open</journal><volume>7</volume><journalNumber>2</journalNumber><paginationStart>e013443</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2044-6055</issnPrint><issnElectronic>2044-6055</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2017</publishedYear><publishedDate>2017-02-01</publishedDate><doi>10.1136/bmjopen-2016-013443</doi><url>http://dx.doi.org/10.1136/bmjopen-2016-013443</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2023-05-30T14:06:07.2736664</lastEdited><Created>2023-05-16T13:34:03.3693171</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Bridie</firstname><surname>Evans</surname><orcid>0000-0003-0293-0888</orcid><order>1</order></author><author><firstname>Khalid</firstname><surname>Ali</surname><order>2</order></author><author><firstname>Jenna</firstname><surname>Bulger</surname><order>3</order></author><author><firstname>Gary A</firstname><surname>Ford</surname><order>4</order></author><author><firstname>Matthew</firstname><surname>Jones</surname><order>5</order></author><author><firstname>Chris</firstname><surname>Moore</surname><order>6</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>7</order></author><author><firstname>Alan David</firstname><surname>Pryce</surname><order>8</order></author><author><firstname>Tom</firstname><surname>Quinn</surname><order>9</order></author><author><firstname>Anne</firstname><surname>Seagrove</surname><orcid/><order>10</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>11</order></author><author><firstname>Shirley</firstname><surname>Whitman</surname><order>12</order></author><author><firstname>Nigel</firstname><surname>Rees</surname><order>13</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling	v2 63477 2023-05-16 Referral pathways for patients with TIA avoiding hospital admission: a scoping review 6098eddc58e31ac2f3e070cb839faa6a 0000-0003-0293-0888 Bridie Evans Bridie Evans true false d063b18627093a02f325955f76eeeb76 Matthew Jones Matthew Jones true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false 33ab56cb67d7b1ef58f0280af1744e0d Anne Seagrove Anne Seagrove true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2023-05-16 HDAT AbstractObjective 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. Journal Article BMJ Open 7 2 e013443 BMJ 2044-6055 2044-6055 1 2 2017 2017-02-01 10.1136/bmjopen-2016-013443 http://dx.doi.org/10.1136/bmjopen-2016-013443 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 2023-05-30T14:06:07.2736664 2023-05-16T13:34:03.3693171 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Bridie Evans 0000-0003-0293-0888 1 Khalid Ali 2 Jenna Bulger 3 Gary A Ford 4 Matthew Jones 5 Chris Moore 6 Alison Porter 0000-0002-3408-7007 7 Alan David Pryce 8 Tom Quinn 9 Anne Seagrove 10 Helen Snooks 0000-0003-0173-8843 11 Shirley Whitman 12 Nigel Rees 13
title	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
spellingShingle	Referral pathways for patients with TIA avoiding hospital admission: a scoping review Bridie Evans Matthew Jones Alison Porter Anne Seagrove Helen Snooks
title_short	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
title_full	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
title_fullStr	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
title_full_unstemmed	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
title_sort	Referral pathways for patients with TIA avoiding hospital admission: a scoping review
author_id_str_mv	6098eddc58e31ac2f3e070cb839faa6a d063b18627093a02f325955f76eeeb76 fcc861ec479a79f7fb9befb13192238b 33ab56cb67d7b1ef58f0280af1744e0d ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv	6098eddc58e31ac2f3e070cb839faa6a_*_Bridie Evans d063b18627093a02f325955f76eeeb76__Matthew Jones fcc861ec479a79f7fb9befb13192238b__Alison Porter 33ab56cb67d7b1ef58f0280af1744e0d__Anne Seagrove ab23c5e0111b88427a155a1f495861d9_**_Helen Snooks
author	Bridie Evans Matthew Jones Alison Porter Anne Seagrove Helen Snooks
author2	Bridie Evans Khalid Ali Jenna Bulger Gary A Ford Matthew Jones Chris Moore Alison Porter Alan David Pryce Tom Quinn Anne Seagrove Helen Snooks Shirley Whitman Nigel Rees
format	Journal article
container_title	BMJ Open
container_volume	7
container_issue	2
container_start_page	e013443
publishDate	2017
institution	Swansea University
issn	2044-6055 2044-6055
doi_str_mv	10.1136/bmjopen-2016-013443
publisher	BMJ
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url	http://dx.doi.org/10.1136/bmjopen-2016-013443
document_store_str	0
active_str	0
description	AbstractObjective 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.
published_date	2017-02-01T14:06:06Z
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Referral pathways for patients with TIA avoiding hospital admission: a scoping review

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