{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:22:38Z","timestamp":1765603358519,"version":"3.48.0"},"reference-count":30,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Referrals to the Stroke prevention clinic with incomplete preliminary investigations decrease clinic capacity due to additional workload and the need for multiple follow-ups. We aimed to improve the efficacy of the initial visit by increasing the completion rate of vascular imaging in a quality improvement (QI) project. Methods: This is a quasi-experimental study with three phases: Phase 1: Surveillance; Phase 2: Stakeholder feedback-informed intervention development (physicians and clinic staff); and Phase 3: Intervention. Interventions included a new standardized specific physician triage form listing required investigations (brain imaging, vascular imaging, cardiac tracing), and a nurse-led pre-visit via telephone. The primary outcome measure was the completion of vascular imaging by the time of visit, assessed using multivariable logistic regression adjusted for age (in years), sex, and triage category. Results: The study\u2019s inclusion criteria were met by 397 patients, with a mean age of 67.7 \u00b1 13.2 years; 47.8% were female, and 62.9% (250) were diagnosed with vascular events. An increase in vascular imaging before the initial visit was observed in Phase 3 (148\/199, 75.5%) compared to Phase 1 (121\/198, 61.1%), with an adjusted Odds ratio of 1.77 (95% CI 1.2\u20132.8; p = 0.01). A trend toward fewer follow-up visits was observed in Phase 3 (23.1%) compared with Phase 1 (31.8%; p = 0.052). Conclusions: Implementing a standardized triage process and a nurse-led pre-visit may improve completion of vascular imaging before patients visit the stroke prevention clinic. Further QI studies are required to improve the completion rate of rhythm monitoring in this patient group to enable early detection and management of atrial fibrillation.<\/jats:p>","DOI":"10.3390\/jcm14248780","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T14:30:17Z","timestamp":1765463417000},"page":"8780","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Augmenting the Efficacy of the Initial Patient Visit to the Stroke Prevention Clinic: A Quality Improvement Project"],"prefix":"10.3390","volume":"14","author":[{"given":"Anastasia","family":"Howe","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB T0B4J2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunpreet Kaur","family":"Cheema","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah","family":"Saleh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-7431","authenticated-orcid":false,"given":"Thomas","family":"Jeerakathil","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Mathura","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4794-2882","authenticated-orcid":false,"given":"Mahesh","family":"Kate","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Is Transient Ischemic Attack a Medical Emergency? An Evidence-Based Analysis","volume":"15","author":"Sehatzadeh","year":"2015","journal-title":"Ont. Health Technol. Assess. Ser."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1161\/01.STR.0000196957.55928.ab","article-title":"Time Is Brain\u2014Quantified","volume":"37","author":"Saver","year":"2006","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/S0140-6736(07)61448-2","article-title":"Effect of Urgent Treatment of Transient Ischaemic Attack and Minor Stroke on Early Recurrent Stroke (EXPRESS Study): A Prospective Population-Based Sequential Comparison","volume":"370","author":"Rothwell","year":"2007","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S1474-4422(07)70248-X","article-title":"A Transient Ischaemic Attack Clinic with Round-the-Clock Access (SOS-TIA): Feasibility and Effects","volume":"6","author":"Meseguer","year":"2007","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1161\/STROKEAHA.110.586842","article-title":"Stratified, Urgent Care for Transient Ischemic Attack Results in Low Stroke Rates","volume":"41","author":"Wasserman","year":"2010","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1159\/000331919","article-title":"Management of Patients with Transient Ischemic Attack Is Safe in an Outpatient Clinic Based on Rapid Diagnosis and Risk Stratification","volume":"32","author":"Haberl","year":"2011","journal-title":"Cerebrovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1097\/JXX.0000000000000622","article-title":"Feasibility and Safety of a Rapid-Access Transient Ischemic Attack Clinic","volume":"34","author":"Hermanson","year":"2022","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2136644","DOI":"10.1001\/jamanetworkopen.2021.36644","article-title":"Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-Analysis","volume":"5","author":"Shahjouei","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Shahjouei, S., Seyedmirzaei, H., Abedi, V., and Zand, R. (2023). Transient Ischemic Attack Outpatient Clinic: Past Journey and Future Adventure. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134511"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/MLR.0000000000000499","article-title":"Temporal Trends in the Use of Investigations After Stroke or Transient Ischemic Attack","volume":"54","author":"Ng","year":"2016","journal-title":"Med. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7326\/0003-4819-113-1-53","article-title":"Use of Ambulatory Electrocardiographic (Holter) Monitoring","volume":"113","author":"Dimarco","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"95.e11","DOI":"10.1016\/j.amjmed.2013.10.003","article-title":"Comparison of 24-Hour Holter Monitoring with 14-Day Novel Adhesive Patch Electrocardiographic Monitoring","volume":"127","author":"Barrett","year":"2014","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1148\/radiol.2015151030","article-title":"Imaging Paradigms in Acute Ischemic Stroke: A Pragmatic Evidence-Based Approach1","volume":"277","author":"Menon","year":"2015","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1177\/1747493018786616","article-title":"Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018","volume":"13","author":"Boulanger","year":"2018","journal-title":"Int. J. Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1503\/cmaj.081148.R2","article-title":"Canadian Best Practice Recommendations for Stroke Care (Updated 2008)","volume":"179","author":"Lindsay","year":"2008","journal-title":"Can. Med. Assoc. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1177\/17474930231156753","article-title":"A Systematic Review and Synthesis of Global Stroke Guidelines on Behalf of the World Stroke Organization","volume":"18","author":"Mead","year":"2023","journal-title":"Int. J. Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e2093","DOI":"10.1212\/WNL.0000000000207201","article-title":"Effects of a Province-Wide Triaging System for TIA","volume":"100","author":"Jeerakathil","year":"2023","journal-title":"Neurology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1161\/STROKEAHA.109.547497","article-title":"Urgency of Carotid Endarterectomy for Secondary Stroke Prevention: Results from the Registry of the Canadian Stroke Network","volume":"40","author":"Gladstone","year":"2009","journal-title":"Stroke"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gholamzadeh, M., Abtahi, H., and Ghazisaeeidi, M. (2021). Applied Techniques for Putting Pre-Visit Planning in Clinical Practice to Empower Patient-Centered Care in the Pandemic Era: A Systematic Review and Framework Suggestion. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06456-7"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1056\/NEJMoa1412981","article-title":"One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke","volume":"374","author":"Amarenco","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_21","first-page":"1489","article-title":"Benefit of a Nurse-Led Telephone-Based Intervention Prior to the First Urogynecology Outpatient Visit: A Randomized-Controlled Trial","volume":"32","author":"Beitl","year":"2020","journal-title":"Int. Urogynecol. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jopan.2014.08.147","article-title":"The Effectiveness of Nurse-Led Preoperative Assessment Clinics for Patients Receiving Elective Orthopaedic Surgery: A Systematic Review","volume":"31","year":"2016","journal-title":"J. Perianesthesia Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1002\/1529-0131(200106)45:3<295::AID-ART263>3.0.CO;2-3","article-title":"Pre-Appointment Management of New Patient Referrals in Rheumatology: A Key Strategy for Improving Health Care Delivery","volume":"45","author":"Harrington","year":"2001","journal-title":"Arthritis Care Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e101082","DOI":"10.1136\/bmjhci-2024-101082","article-title":"Y The Feasibility and Effectiveness of Telecare Consultations in a Nurse-Led Post-Acute Stroke Clinic","volume":"32","author":"Wong","year":"2025","journal-title":"BMJ Health Care Inform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/JNN.0000000000000670","article-title":"Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients","volume":"54","author":"Mitchell","year":"2022","journal-title":"J. Neurosci. Nurs."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/S0140-6736(10)61197-X","article-title":"10-Year Stroke Prevention after Successful Carotid Endarterectomy for Asymptomatic Stenosis (ACST-1): A Multicentre Randomised Trial","volume":"376","author":"Halliday","year":"2010","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.cct.2016.01.012","article-title":"Pre-Visit Prioritization for Complex Patients with Diabetes: Randomized Trial Design and Implementation within an Integrated Health Care System","volume":"47","author":"Grant","year":"2016","journal-title":"Contemp. Clin. Trials"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1001\/jama.293.10.1223","article-title":"Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes","volume":"293","author":"Garg","year":"2005","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1161\/STROKEAHA.115.009616","article-title":"Prevalence of Individuals Experiencing the Effects of Stroke in Canada: Trends and Projections","volume":"46","author":"Krueger","year":"2015","journal-title":"Stroke A J. Cereb. Circ."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13012-016-0396-4","article-title":"Achieving Change in Primary Care-Causes of the Evidence to Practice Gap: Systematic Reviews of Reviews","volume":"11","author":"Lau","year":"2016","journal-title":"Implement. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8780\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:18:44Z","timestamp":1765603124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":30,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248780"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248780","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}