Acute GP service
This is a site intended for clinicians - all guidelines must be interpreted in the context of clinical risk assessment
Transient Ischaemic Attack (TIA)
How the TIA clinic works
The Cornwall Stoke Service will see patients in the TIA clinic after triaging their priority, based on your referral. Please be aware that the ABCD2 score is being removed from local and national guidelines.
• High risk patients will usually be seen within 24hrs of onset of the transient ischaemic attack
• Low risk patients will be seen within 7 days of onset of the transient ischaemic attack.
The TIA Clinic will also see patients with new onset stroke which has not resolved and has resulted in a minor disability, for example slurred speech or minor limb weakness. These patients must be safe at home pending their appointment.
Revised Referral Criteria
• It is felt that primary care or community virtual triage of patients, and subsequent referral into the clinic, is leading to a higher percentage of patients whose presentation is not consistent with TIA. Referrals into clinic that are not clinically indicated may be rejected.
• There have been several referrals where the patient has a very serious presentation upon attending clinic. For patient safety, the TIA clinic has updated its referral criteria. Patients must have a face-to-face review by a primary care or community clinician prior to a TIA clinic referral being made.
ADMIT via ED if:
Ongoing symptoms - Patients with ongoing stroke symptoms should be admitted to the emergency department for stroke pathway, typically via a 999 ambulance if less than 6hrs or awaking with symptoms.
>1 TIA in a week - If patients have had more than one episode of neurological deficit within a week, this should be treated as a crescendo TIA and admitted to ED.
Office hours: Monday-Friday 09:00-17:00. Referrals are picked up and actioned seven days a week. Clinics are held daily (see below).
Remember to inform the patient to AVOID DRIVING UNTIL SEEN IN TIA CLINIC where they will be advised further.
If patients have had symptoms suggestive of a TIA they should be referred to the TIA clinic and should be started on Aspirin 300mg as long as their symptoms have completely resolved(1).
1. Revised RCP Guidelines for the management of Transient Ischaemic Attack (October 2016)
* If patients have symptoms or signs of Bell’s palsy: these patients should be treated in primary care, no need for referral.
* If the history suggests transient global amnesia: these patients should be considered for referral to the Neurology team via the Referral Management System.
* If history suggests migraine, consult the following guidelines: https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/neurology/headache
* Please refer patients with probable syncope as the main presentation to the falls and syncope clinic through the Referral Management System.
* Driving guidance can be found at https://www.gov.uk/guidance/assessing-fitness-to-drive-a-guide-for-medical-professionals
* If your patient is very frail, difficult mobility/ transport logistics, acute treatment would either not be recommended or tolerated, would not be a surgical candidate or already on secondary prevention for stroke – please consider managing pragmatically in primary care.
* Some patients or relatives of those patients, who are lacking capacity, do not wish to endure the transport logistics to come to clinic when there is little to gain– please consider managing pragmatically in primary care.