Establishing an Advanced Practice Provider-led Transient Ischemic Attack clinic: A Quality Improvement Initiative

Author

• Brittany A. Young, University of KentuckyFollow

Date Available

4-15-2026

Year of Publication

2026

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Sheila Melander

Committee Member

Dr. Jessica Lee

Faculty

Dr. Candice Falls

Abstract

Background: Due to lack of subspecialized neurological care in many rural community settings, care in tertiary hospitals is in demand. Insufficient care pathways can lead to lack of bed and provider availability. Advanced Practice Provider Transient Ischemic Attack clinics have been shown to be safe alternatives to hospital admission, for patients who meet criteria. This study targeted practice change at a 1000 bed tertiary academic hospital.

Methods: The quasi-experimental study sample inclusion criteria included Transient Ischemic Attack patients presenting to the emergency department with an ABCD2 < 4, complete symptom resolution, and no new cardiac changes on monitoring. A pre and post survey with educational PowerPoint intervention was provided to all emergency department and Neurology providers and nurses. A Transient Ischemic Attack clinic was established with a corresponding order set to be utilized for streamlined outpatient work up.

Results: During the pilot period, 29 admissions were deferred with 69% of patients completing the pathway. The order set was used 76% of the time. Of the patients referred, the average age was 68 years with 59% being women. The Transient Ischemic Attack clinic educational intervention PowerPoint showed a statistically significant knowledge improvement (p=.008). 91% of respondents reported that they would be extremely or somewhat likely to recommend the Transient Ischemic Attack clinic when appropriate.

Conclusions: The pilot suggests the educational intervention PowerPoint allowed providers to refer appropriate patients to the clinic. The clinic pathway successfully triaged inpatient appropriate admissions. There is an opportunity to improve compliance with the complete pathway, starting with the order set.

Recommended Citation

Young, Brittany A., "Establishing an Advanced Practice Provider-led Transient Ischemic Attack clinic: A Quality Improvement Initiative" (2026). DNP Projects. 513.
https://uknowledge.uky.edu/dnp_etds/513