Evaluation of the Extent to Which Massachusetts General Hospital Emergency Department Triage of Transient Ischemic Attack Patients Aligns With Virtual TIA Clinic Protocol: A Pilot Cross-Sectional Medical Record-Review to Inform Care Redesign Efforts

The Virtual TIA Clinic Protocol was developed as part of the Partners Care Redesign effort to reduce costs and increase quality in the care of patients presenting with symptoms of transient ischemic attack, through risk stratification, triage, and follow-up based on factors including the ABCD2 score. The work presented here is a small N, pilot cross-sectional study which compares actual practice in the MGH ED to what the protocol would suggest, in an effort both to validate the components of the protocol and to better understand further opportunities to create value in the care of this patient population. It was found that actual practice resulted in triage patterns similar to what would have been dictated by the protocol in question. This suggests that full implementation of the protocol – with the costs associated – may not be justified. Further work could involve refinement of the protocol to achieve the desired effect on triage, with future, similar studies made more effective by a code to designate patients in whom TIA is possible but who do not ultimately receive the code for such under the current documentation system