Efficacy and Safety of a Transient Ischaemic Attack (TIA) Electronic Support Tool

Utilisation of a TIA electronic decision support (EDS) tool during the management of patients suspected of having suffered a TIA or stroke. The tool is a web based module that GPs access by clicking a menu button situated on the navigation bar of their practice management software that links them to the software provider (BPAC.Inc) module site. From there they select the TIA/Stroke EDS tool from a menu. Once selected a single page of tick boxes opens up for GPs to complete covering items such as relevant aspects of history of presenting illness and a brief focused physical examination. Fields for relevant past medical history (e.g. diabetes and smoking history) are automatically populated by extracting data directly from the practice management system. Completing the page of background and clinical presentation data takes approximately 2-5 minutes depending on the GP’s familiarity with the tool. Based on this information the software confirms or rejects TIA/stroke as the likely diagnosis. If TIA or stroke is confirmed a triage recommendation is generated based on a validated risk score (ABCD2) supplemented by several other variables taken from the New Zealand TIA guidelines and clinical experience. If patients are triaged into the “low risk” category GPs are offered the option of either referring them to a specialist TIA clinic or to manage the patients themselves in the community. If community management is selected a step by step outline is provided with links to pre-populated relevant prescriptions, radiology referral forms, and life-style information leaflets. If patients are triaged into the “high risk” category GPs are advised to refer them to hospital for specialist assessment and diagnostic work-up to be achieved within 24 hours and GPs are not offered the community management option. However, if a GP feels that ED referral is not appropriate in any given situation (e.g. the patient refuses to attend ED) then the GP has the option to override this recommendation and refer patients to an outpatient specialist TIA clinic instead, as long as a reason for overriding the recommendation is specified. Referrals to hospital are automatically generated and contain all required information to allow the specialist to prioritise them appropriately. In the case of a hyper-acute stroke that is within the 4.5 hour thrombolysis window the tool is immediately aborted and the GP is advised to call 111 for emergent hospital transfer to a centre where stroke thrombolysis is available. A GP sees on average 1 TIA patient per month which also represents the average anticipated frequency of EDS use. Each TIA presentations requires only a single use of the EDS.