RT Journal Article
SR Electronic
T1 PP24 The transient ischaemic attack 999 emergency referral (tier) feasibility trial: development of a complex intervention
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP e9
OP e9
DO 10.1136/emermed-2017-207114.24
VO 34
IS 10
A1 Rees, Nigel
A1 Ali, Khalid
A1 Bulger, Jenna
A1 Dewar, Richard
A1 Edwards, Adrian
A1 Evans, Bridie
A1 Evans, Lyn
A1 Ford, Gary
A1 Hampton, Chelsey
A1 John, Roger
A1 Jones, Charlene
A1 Moore, Chris
A1 Porter, Alison
A1 Pryce, Alan
A1 Representative, Lay
A1 Quinn, Tom
A1 Seagrove, Anne
A1 Snooks, Helen
A1 Watkins, Alan
A1 Whitman, Shirley
YR 2017
UL http://emj.bmj.com/content/34/10/e9.1.abstract
AB Background Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. NICE (2008) recommends patients with TIA are seen in specialist clinics within 24 hours (if high risk) and seven days (if low risk).We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention was then to be used in the TIER feasibility trial, in line with the MRC guidance on staged development and evaluation of complex interventions.Methods We conducted three interrelated activities to produce the TIER intervention:Survey of UK Ambulance Services (n=13) to gather information about TIA pathways already in useScoping review of literature describing prehospital care of patients with TIASynthesis of data and definition of the intervention by specialist panel of: paramedics; ED and stroke consultants; service users; ambulance service managers.Results The panel defined the TIER intervention to include:Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (<7 day) specialist review at TIA clinicPatient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinicReferral process via clinical desk in ambulance control roomTraining package for paramedicsAgreement with TIA clinic service provider to ensure rapid review of referred patientsConclusion We followed MRC guidance to develop a clinical intervention which assesses and refers low risk TIA patients requesting 999 care. We will test feasibility of implementing and evaluating this in the TIER feasibility trial. We will then develop a fully powered randomised multicentre trial, if findings indicate this is appropriate.