Objectives The ABN's 2011 report on local services proposed a shift to take control of acute neurological presentations. 15% of admissions are neurological (33% stroke, 25% seizures, 20% headache), the 3rd commonest. Though inpatient neurological review demonstrates diagnostic and management value, very few are seen. Stroke care is increasingly specialised, with neurologists seldom involved acutely. However, the British Association of Stroke Physicians suggests it be delivered by collaboration of all relevant specialties. This study uses TIA as a model to identify attributes to apply in other acute neurological presentations, as well as identify improvements in TIA care.
Design Single centre DGH. Retrospective study of medical notes. Sample population 100 suffering TIA from 1/4–30/12/11.
Results Almost all receive immediate aspirin and subsequent secondary prevention. Risk of stroke assessed in >90%. Specialist assessment occurred in 80% of low risk patients within 1 week of onset and 70% of high within 24 h. Carotid imaging within 1 week in 80%, and endarterectomy within 2 weeks in 80% with significant stenosis. Requirements of such a service include a dedicated ward, consultant, junior and nursing staff, access to imaging and on-call rotas.
Conclusions Weekend presentation of high risk TIA is a challenge as specialist clinics cannot assess within 24 h. This study established a weekend TIA service, the results of which will be concluded before May. Full report details lessons learnt from TIA that can improve care of acute neurological presentations, including seizure and headache.