Safety and Hospital Costs Averted Using a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Strokes: The RAVEN Clinic

This is absolutely appalling, suggesting that TIAs and minor strokes are too good to treat because of cost concerns.  You better hope this doesn't happen to you because the damage won't magically disappear.

 

Safety and Hospital Costs Averted Using a Rapid Outpatient Management Strategy for Transient Ischemic Attack and Minor Strokes: The RAVEN Clinic

Show all authors

Steven D. Shapiro, MD, Amelia K. Boehme, PhD, MS, Bernard P. Chang, MD, PhD, ...

First Published November 5, 2020 Research Article 

https://doi.org/10.1177/1941874420972236

Article information

Abstract

Study Objective:

Patients presenting to emergency departments (ED) with transient ischemic attack and minor strokes (TIAMS) are often admitted for evaluation, though experience in other countries have suggested that an expedited outpatient care models may be a safe alternative. We hypothesized that a rapid access clinic for select TIAMS was feasible and would avert hospitalization costs.

Methods:

This retrospective analysis included patients presenting to our institution’s ED with TIAMS and NIHSS ≤5 in calendar year 2017. We referred low-risk patients with TIAMS to a Rapid Access Vascular Evaluation-Neurology (RAVEN) clinic within 24 hours of ED discharge. We identified admitted patients who met RAVEN criteria at ED presentation. Rates of follow-up to the RAVEN clinic were recorded. Financial data collected included total hospital costs and time spent in the ED, as well hospital length of stay for admitted patients with low-risk TIAMS.

Results:

In 2017, 149 patients were referred to RAVEN clinic and 50 patients were admitted. Of the RAVEN patients 99 (94%) appeared as scheduled. None had clinical changes between ED discharge and clinical evaluation. One patient required hospitalization at the RAVEN evaluation. When compared to RAVEN patients, admitted patients had significantly higher $7,719 (SD 354) total hospital costs and were hospitalized for 2 days on average. Overall, the RAVEN strategy averted approximately $764,000 in hospitalization costs and 208 hospital bed-days in accounting year 2017.(But what the hell happened to those you didn't treat? Did they magically recover?)

Conclusions:

For select patients presenting with TIAMS without disabling deficits, a rapid outpatient evaluation may be feasible while averting significant total hospital costs and preserving inpatient hospital beds.(My god, your focus is completely wrong, get the hell out of the stroke business and take your cost containment someplace that doesn't affect lives.)

Keywords stroke, cerebrovascular disorders, ischemic attack, transient, cerebrovascular disorders, safety, techniques

Access Options