Utility of a primary care based transient ischaemic attack electronic decision support tool: a prospective sequential comparison

Background: Stroke is a major cause of death and disability worldwide. Reducing the incidence of stroke has the potential to not only improve health outcomes, but also lead to significant cost savings for health services. Transient ischaemic attacks (TIA) can herald an imminent stroke and following a TIA early initiation of best medical therapy significantly reduces the risk of subsequent stroke. To achieve time targets rapid access stroke specialist services have been promoted; however, a number of resource related barriers can impede specialist access and cause unnecessary time delays. Cross sector collaboration led to the development of a primary care based TIA/Stroke electronic decision support (EDS) tool. This study aimed to assess the impact of this tool on improving access and reducing management delays. Methods: This is a prospective before (2009) versus after (2011) study of the effect on process of care following the implementation of EDS assisted TIA management in primary care. All patients presenting with TIA to secondary services were included. Outcomes assessed were TIA Guideline adherence and patient safety. Results: Over the study period 266 patients presented for TIA assessment (130 in 2009 and 136 in 2011). Following EDS implementation the median delay to specialist assessment fell from 10 days in 2009 to three days in 2011 (HR 1.45; 95% CI 1.13-1.86; p = 0.001), the number of patients achieving optimal medical therapy within 24 hours rose from 43% to 57% (RR 1.33; 95% CI 1.02-1.71; p = 0.04), carotid and CT imaging were achieved significantly faster (HR 1.52 (1.02-2.26) p = 0.003 and HR 1.34 (1.16-1.78 p = 0.002) respectively), and there were no adverse events associated with EDS use. Conclusion: The availability of TIA/Stroke electronic decision support in the primary care setting was associated with reductions in management delays without compromising patient safety.