Background: It is estimated that in the US, between 200 and 500 thousand TIA’s are reported each year. Half of those patients never report it to their physician. TIA’s once regarded as benign are now recognized as an emergent warning sign of underlying disease and possible impending stroke. By the time many of these patients get to Cedars Sinai, they are asymptomatic and can’t understand the need for a long hospital admission. In 2011 we started our TIA program that enabled us to work up a patient and potentially discharge them from the hospital in 23 hours. The program was a success and patient length of stay decreased dramatically. In 2013, we noted that the length of stay was gradually increasing again. Re-Education efforts for staff about the TIA program proved ineffective, and made only a slight decrease in length of stay. We noted that TIA patients could potentially be admitted anywhere in the hospital and many were not being captured in the system. We needed a better, more consistent solution. We decided to admit and cohort all TIA patients to the Medical Observation Unit (MOU).
Researchable Questions: Would cohorting all TIA patients in the Medical Observation Unit show a consistent decrease in length of stay? Is there a benefit to putting all TIA patients in the Medical Observation Unit?
Methods: We began extensive education with staff and management of the MOU. We educated on the importance of monitoring asymptomatic TIA patients, testing specific to these patients, and how we smoothly expedite them through the system under CODE TIA. In April 2015 all TIA patients were admitted into the MOU
Conclusion: Cohorting TIA patients to the MOU has proven to be a success. Prior to the initiation of the cohorting process, TIA length of stay was 1.9 days. The current length of stay for a TIA patient in the MOU is 0.87 days. This has been dramatic and consistent decrease for almost two years. We also noted that several Code Brains have been called from this unit as the nurses are hypervigilant at monitoring these asymptomatic patients. Several of these patients have been quickly treated with tPA and have had only small or averted strokes because of the quick response from MOU nurses.