National survey of management of transient ischaemic attack in Australia: take immediate action.
OBJECTIVE
To understand the current organisation of services for people with transient ischaemic attack (TIA) and the processes of assessment and management across Australian hospitals.


METHODS
Cross-sectional survey in 2008 of 134 Australian hospitals, mostly urban centres that treat large numbers of stroke patients.


METHODS
Survey questions covered assessment, early management and follow-up practices, as well as organisation of services for TIA.


RESULTS
Seventy-four hospitals (55%) responded: 47 (64%) reported access to a stroke unit, and 19 (26%) to a specialist clinic for TIA. Initial assessment included blood tests, electrocardiogram and brain computed tomography at most sites (92%-94%), and carotid imaging at more than half (65%), but magnetic resonance imaging at only 3% of sites. A tool to stratify the risk of subsequent stroke was used at 38 sites (51%), more commonly in hospitals with a stroke unit than in those without such a unit (64% v 30%; P = 0.005). Treatment was initiated at the initial assessment at 42 sites (58%), more commonly at stroke unit than non-stroke unit sites (68% v 37%; P = 0.007). Formalised policies for management of TIA patients were used at 38 sites (54%), with clear differences between sites with a stroke unit and those without (70% v 25%; P < 0.001).


CONCLUSIONS
Access to rapid assessment and management services for TIA varies considerably between Australian hospitals. The presence of organised stroke care at a hospital leads to improved processes of care for patients presenting with TIA.
Price
Christopher J
CJ
Stroke Services, National Stroke Foundation, Melbourne, VIC, Australia. cprice@strokefoundation.com.au
Blacker
David J
DJ
Grimley
Rohan S
RS
Dewey
Helen M
HM
Gerraty
Richard P
RP
Koblar
Simon A
SA
Denisenko
Sonia M
SM
Storey
Catherine E
CE
Bladin
Christopher F
CF
Hill
Kelvin M
KM
D001315:Australia / Q000453:epidemiology; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D055502:Secondary Prevention / Q000458:organization & administration* / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology / Q000628:therapy