Lee, Eun Hye

Introduction: Previous studies have established the safety and economic benefits of outpatient Transient Ischemic Attack (TIA) management, highlighting reduced expenses for outpatient evaluation. This context underscores the potential advantages of refined outpatient TIA management, a focus of our study, through the implementation of a novel expedited outpatient TIA workflow and assessment of its economic, administrative and clinical impact. Methods: We implemented a novel TIA pathway including streamlined assessments by emergency department (ED) physicians, a structured expedited set of diagnostic tests and outpatient follow-up with vascular neurologists within 48-72 hours of ED presentation. We conducted a retrospective cost-efficacy analysis, contrasting two phases: pre-implementation (standard ED-to-hospital admission TIA workflow from May 1, 2020 - December 31, 2020) and post-implementation (ED-to- outpatient TIA workflow from May 1, 2021 - December 31, 2021). We also compared the clinical outcomes of patients with a final diagnosis of TIA or minor ischemic stroke syndrome from the implementation cohort (May 2021-May 2022) with those from an ABCD2-matched inpatient TIA cohort evaluated in the pre-implementation period (2017-2021). Results: The newly implemented outpatient TIA workflow resulted in a 7% decrease in admissions to hospital observation status, 14.8% reduction in hospital admissions, whereas ED discharge rates rose by 20.4%. Within 8 months, these changes equated to 21 fewer hospitalizations or admissions, reducing costs by approximately $103,320 (Figure1). Laboratories, diagnostic imaging, and neurology evaluations were completed faster in the inpatient pathway. Both pathways had similar vascular risk factors and outcomes regarding final diagnosis, - diagnostic testing achieved, preventative treatments prescribed, stroke/TIA recurrences, re-admissions, TIA-related morbidity and mortality, and related ED return visits (Table 1). Conclusion: The deployment of an optimized outpatient TIA management workflow at Mayo Clinic Arizona had demonstrated improved administrative and cost efficiency, with similar clinical outcomes as inpatient TIA pathway. This investigation corroborates the efficacy of workflow enhancements in outpatient TIA settings and suggests a scalable model for analogous strategies in other medical centers.