Shapiro Steven D, Boehme Amelia K, Chang Bernard P, Miller Eliza C, Willey Joshua, Elkind Mitchell S V
Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Neurohospitalist. 2021 Apr;11(2):107-113. doi: 10.1177/1941874420972236. Epub 2020 Nov 5.
Patients presenting to emergency departments (ED) with transient ischemic attack and minor strokes (TIAMS) are often admitted for evaluation, though experience in other countries have suggested that an expedited outpatient care models may be a safe alternative. We hypothesized that a rapid access clinic for select TIAMS was feasible and would avert hospitalization costs.
This retrospective analysis included patients presenting to our institution's ED with TIAMS and NIHSS ≤5 in calendar year 2017. We referred low-risk patients with TIAMS to a Rapid Access Vascular Evaluation-Neurology (RAVEN) clinic within 24 hours of ED discharge. We identified admitted patients who met RAVEN criteria at ED presentation. Rates of follow-up to the RAVEN clinic were recorded. Financial data collected included total hospital costs and time spent in the ED, as well hospital length of stay for admitted patients with low-risk TIAMS.
In 2017, 149 patients were referred to RAVEN clinic and 50 patients were admitted. Of the RAVEN patients 99 (94%) appeared as scheduled. None had clinical changes between ED discharge and clinical evaluation. One patient required hospitalization at the RAVEN evaluation. When compared to RAVEN patients, admitted patients had significantly higher $7,719 (SD 354) total hospital costs and were hospitalized for 2 days on average. Overall, the RAVEN strategy averted approximately $764,000 in hospitalization costs and 208 hospital bed-days in accounting year 2017.
For select patients presenting with TIAMS without disabling deficits, a rapid outpatient evaluation may be feasible while averting significant total hospital costs and preserving inpatient hospital beds.
因短暂性脑缺血发作和轻度卒中（TIAMS）前往急诊科（ED）就诊的患者通常会住院接受评估，不过其他国家的经验表明，快速门诊护理模式可能是一种安全的替代方案。我们推测，为特定TIAMS患者设立的快速通道诊所是可行的，并且可以避免住院费用。
这项回顾性分析纳入了2017年在我们机构急诊科因TIAMS就诊且美国国立卫生研究院卒中量表（NIHSS）评分≤5的患者。我们在急诊科出院后24小时内将低风险TIAMS患者转诊至快速通道血管评估-神经科（RAVEN）诊所。我们确定了在急诊科就诊时符合RAVEN标准的住院患者。记录了到RAVEN诊所的随访率。收集的财务数据包括总住院费用、在急诊科的停留时间，以及低风险TIAMS住院患者的住院时长。
2017年，149名患者被转诊至RAVEN诊所，50名患者住院。在RAVEN诊所的患者中，99名（94%）按计划就诊。从急诊科出院到临床评估期间，无一例有临床变化。1名患者在RAVEN评估时需要住院。与RAVEN诊所的患者相比，住院患者的总住院费用显著更高，为7719美元（标准差354），平均住院2天。总体而言，RAVEN策略在2017财年避免了约76.4万美元的住院费用和208个住院床位日。
对于某些无致残性神经功能缺损的TIAMS患者，快速门诊评估可能是可行的，同时可避免显著的总住院费用并保留住院床位。
