N.B. RE: TIA Clinic
Due to the upcoming bank holiday weekend all TIA referrals from FridayApril Feb 2nd 12pm – Tuesday Feb 6th 9am need to be treated as ‘weekend TIA referrals’ as there is no OPD clinic on Monday Feb 5th
- As usual all TIA patients with ‘high risk’ clinical features should be referred for urgent admission, as should all suspected TIA patients with an ABCD2 Score of ≥ 4
- ‘Lower risk’ TIA patients seen by their GP, or the Emergency Department staff from:
Friday Feb 2nd 12pm – Tuesday Feb 6th 9am
who have an ABCD2 Score of 0-3 will also need to be assessed and possibly admitted under the medical team on call if a TIA is confirmed (a low threshold for referral to the medical team is recommended). The medical team staff will subsequently refer patients to the Neurology/Stroke Service, as appropriate.
The flagship, Daily, Weekday, ‘One-Stop’ RASP service for patients in our catchment area with suspected TIAs operates under the co-direction of Prof. Dominick McCabe and Dr. Dan Ryan, in collaboration with our RASP service colleagues.
An ‘e-mail-based RASP referral pathway’ replaced the urgent ‘faxed-based referral pathway’ in April 2019. Please ensure that you include your patient’s name and DOB in the ‘subject information box’ of the email referral and attach the latest compulsory ‘RASP Service e-mail referral proforma’ The form must include your own contact details, and the patient’s details and contact number(s). The proforma has been slightly modified to make the ‘urgent admission criteria’ even clearer, to allow you to type in the information on the proforma which can be saved and sent as an attachment, or to print the proforma as before, handwrite in relevant information, scan and attach the completed scanned document to your email.
The referral will be urgently prioritised by the attending Consultant Neurologist or Stroke Physician who is covering the service. An urgent appointment will be offered, if deemed appropriate for the RASP service based on the information on the RASP referral proforma and any attached documentation which you may decide to send. We aim to allocate an appointment within 24 hours to urgently assess these patients. You will be contacted by our team if an alternative referral pathway is advisable for your patient.
Prof Dominick McCabe / Dr Allan McCarthy (Vascular Neurology) will run the clinic service one week, and Dr Dan Ryan / Prof Rónán Collins / Prof Tara Coughlan / Prof Des O’Neill / Dr James Mahon (ARHC/Stroke Service) will run the service the following week.
All TIA patients with ‘high risk’ clinical features should be referred to ED for urgent assessment with a view to admission with the revised TUH RASP referral proforma regardless of their ABCD2 Score, as should all suspected TIA patients with an ABCD2 Score of ≥ 4.
‘Lower risk TIA patients’ who do not fulfil any of the high risk admission criteria, and who have an ABCD2 Score of 0-3, should be referred by e-mailing the web-based email-RASP referral proforma to RASP@tuh.ie each day from Monday at 9am to Friday at 12pm.
This email account will not be checked after 12pm on Fridays or at weekends. Therefore, because TIAs are medical emergencies, all suspected TIA patients in the catchment area seen by their GP / Emergency Department (ED) staff at the weekend from 12pm on Friday to 9am on Monday, regardless of their ABCD2 Score, also need to be referred to the ED that day for assessment and possible admission under the medical team on call if a TIA is confirmed (a low threshold for referral to the medical team is recommended). The ED / medical team will initially investigate, treat and subsequently refer patients to the RASP / Stroke Service, as appropriate, on Monday am. Specific arrangements for Bank Holidays will be posted on the website in advance. Following assessment by RASP service staff, urgent decisions re management and secondary prevention, including anti-thrombotic therapy, will be made and communicated to the referring doctor.