Abstract WP162: An Expedited Transient Ischemic Attack Pathway for Early Stroke Prevention in a Community Hospital with Limited Neurology Coverage

Background and Purpose: Prompt evaluation of transient ischemic attack (TIA) is critical to prevent stroke, but delivering timely, guideline-based care can be challenging in community hospitals with limited neurology coverage. At our hospital, low-risk TIA patients were often admitted for observation, with median length of stay (LOS) exceeding 24 hours due to delays in diagnostic workup and follow-up coordination. We implemented an expedited TIA pathway in June 2024 to reduce LOS, initiate secondary prevention, and ensure timely specialist follow-up. Methods: This pre/post intervention quality improvement initiative was conducted in the emergency department of a 329 bed community hospital. Data was collected from 6/2023 to 6/2024 (pre-implementation) and 7/2024 to 6/2025 (post-implementation). The pathway incorporated ABCD2 risk stratification, electronic medical record order sets, protocol driven testing (CT angiogram, rapid stroke MRI, lipid panel, hemoglobin A1C), discharge prescriptions for aspirin and statin, and stroke education. The stroke coordinator facilitated neurology and cardiology follow up (including echocardiogram and Holter monitor) within 7 days. Patients without reliable follow up capacity were admitted. Primary outcomes were ED LOS (hours from arrival to discharge), ED arrival to aspirin administration time (hours), and discharge to specialist follow up time (days). Demographics and outcomes were summarized with medians and interquartile ranges (IQR). Results: Pre-intervention, 110 patients admitted under observation had a median LOS of 27 hours (IQR 26–28.5). Post-intervention, 87 patients were admitted under observation and 76 were discharged via the TIA pathway, with a median LOS of 5 hours (IQR 4–5). The median ED arrival to aspirin administration time was 3.3 hours (IQR 2.6–5.2), supporting early secondary prevention. Discharge to specialist follow up occurred within 5 days (IQR 4–5) for neurology and 7 days (IQR 4–15) for cardiology. Conclusions: An expedited TIA pathway in a resource-limited community hospital reduced LOS by 22 hours, enabled early secondary prevention within guideline-recommended timeframes and met or exceeded the American Heart Association’s target for specialist evaluation within 7 days of symptom onset. These findings warrant further evaluation for sustainability and broader adoption.