TRANSIENT ISCHAEMIC ATTACK 999 EMERGENCY REFERRAL (TIER): FEASIBILITY TRIAL

    loading  Checking for direct PDF access through Ovid

Abstract

Background

Studies demonstrate TIA patients are at risk of further TIAs, stroke and death. TIA incidence is unknown, however estimated at 35 per 100,000 people annually in the UK, costing approximately £7 billion. Many TIA patients call 999, are assessed, stabilised and conveyed to Emergency Department (ED). Rapid assessment of TIA severity and risk and intervention is emerging as the new standard for TIA care leading to alternative pathways with direct referral to specialist services. However, uncertainties exist over this new model of care.

Background

We will develop and assess feasibility of paramedic assessment and referral of low-risk TIA patients directly to TIA clinic for early review, thus providing timely specialist review without: adverse consequences; inconvenience of ED attendance; unnecessary cost to the NHS.

Methods

This feasibility trial is designed to test the methods of a pragmatic cluster randomised trial with a qualitative component. To develop the treatment protocol, training and referral processes, working with clinicians/stakeholders, we will conduct:

Methods

– survey across UK ambulance services to find referral pathways for low-risk TIA patients

Methods

– systematic review of TIA prehospital care

Methods

– paramedic focus groups pre-implementation

Methods

Then:

Methods

– randomise paramedics (intervention/control)

Methods

– recruit patients

Methods

– interview patients, key clinicians and service managers

Methods

– collect routine data

Methods

– hold paramedic focus groups post-implementation

Methods

We will:

Methods

– measure uptake and compliance with treatment protocols

Methods

– validate TIA assessment tool

Methods

– analyse qualitative data

Methods

– pilot recruitment processes

Methods

– test data collection methods

Methods

– estimate key outcomes effect size to inform full trial sample size calculation

Results

Will inform full trial development using criteria: intervention acceptability to practitioners and patients; trial design feasibility; outcome data completeness.

Conclusions

▸ If indicated, full trial conducted

Conclusions

▸ If not, but positive results – advise intervention development for immediate implementation

Conclusions

▸ If not, but negative results – advise delivery of intervention should cease.

Related Topics

    loading  Loading Related Articles