Transient Ischaemic Attack 999 Emergency Referral (TIER)
Research type
Research Study
Full title
Transient Ischaemic Attack 999 Emergency Referral (TIER): feasibility trial
IRAS ID
190685
Contact name
Nigel Rees
Contact email
Sponsor organisation
Welsh Ambulance Services NHS Trust
ISRCTN Number
ISRCTN85516498
Duration of Study in the UK
2 years, months, days
Research summary
This study aims to develop and assess the feasibility of a paramedic referral pathway of patients with low-risk suspected Transient Ischaemic Attack (TIA) directly to TIA clinic for early specialist review, without going to the Emergency Department (ED). TIAs, sometimes referred to as a ’mini stroke’, occur when there is a temporary interruption in the flow of blood to the brain. Symptoms may be similar to that of a stroke. To be classed as a TIA, the symptoms must last less than 24 hours. Patients who have a TIA are at risk of having a stroke. Those at high-risk should be assessed by a specialist within 24 hours. Guidelines state however, that patients with low-risk TIA do not require immediate assessment, and can be assessed by a specialist within one week of the TIA.\n\nCurrently, if a patient calls 999 because they have symptoms of a TIA, paramedics are likely to take them to the ED to be assessed by a doctor. The patient may have to wait several hours to be seen. When the patient is seen by a doctor in the ED, that doctor may refer the patient to TIA clinic, or to the on-call medical doctor. This medical doctor will probably not be a TIA specialist. The outcome of the hospital assessment is, therefore, likely to be a referral to TIA clinic. The patient will have to attend this TIA clinic where a specialist doctor or nurse can assess them again. This duplication of assessment is inconvenient to the patient, and it also wastes NHS resources. This is particularly a problem now, when ED waiting times often exceed the government target of four hours.
REC name
Wales REC 3
REC reference
16/WA/0116
Date of REC Opinion
12 May 2016
REC opinion
Further Information Favourable Opinion