Objective:
To evaluate the effects of an acute 7-day outpatient clinic for minor stroke or transient ischemic attack (TIA).
Methods:
We performed a prospective cohort-study using all patients from an outpatient clinic for patient with suspected minor stroke and TIA between September 2013 and August 2014. The clinic opened in May 2012 as part of centralization of the stroke services in Central Region Denmark. For comparison, we used a matched historic cohort from the same hospital between May 2011 and April 2012 (before the outpatient clinic) and a contemporary cohort from a comparable university hospital from the Capital Region without an outpatient clinic. A risk-assessment tool was used in the outpatient clinic to determine the risk of recurrent stroke and hence a need for a hospital admission.
Results:
The outpatient clinic cohort (OCC) consisted of 1076 patients and we confirmed a neurovascular diagnosis in 510 of the patients (47.4%). Of these, 215 had a stroke and 94 (43.7%) were discharged direct from the outpatient clinic. TIA was confirmed in 171 patients and of these 121 (70.8%) were handled without a hospitalization. In the stroke patients from the OCC there was a shorter length of acute hospital stay (median 1 day) compared to the matched historic cohort (median 3 days); adjusted length of stay ratio of 0.49 (0.33-0.71). Furthermore these stroke patients had a 30-day readmission rate on 3.2 % (0.6-5.7) compared to 11.6 % (6.99-16.2) in the historic cohort; adjusted hazard ratio of 0.23 (0.09-0.59) and increased quality of care captured in 10 process performance measures. We found similar results in comparison with the contemporary cohort. Furthermore, we saw a similar pattern when we compared TIA patients from the OCC to a matched contemporary cohort. According to the risk-assessment, 170 stroke or TIA patients had a ‘low risk’ and were treated without being admitted as inpatients. Only one of these patients experienced a stroke within 7 days (0.59%).
Conclusions:
Overall, the results showed the outpatient set up for minor stroke and TIA was safe and may be an advance compared to hospitalization in stroke units despite use of less bed days. Furthermore, the risk assessment used to select patients in need of an inpatient course seems useful.
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