Transient Ischaemic Attack 999 Emergency Referral (TIER): feasibility trial

To develop and assess the feasibility of 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).

For those patients who do not require immediate hospital care, this will provide timely specialist review without: adverse consequences; the inconvenience of ED attendance; and cost to the NHS. Patients with high-risk TIA will still be taken to ED.

This is a study of an alternative care pathway for patients with low-risk suspected TIA. 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. How high this risk is depends on the 'severity' of the TIA, which can be assessed with a clinical scoring tool. Those at high-risk should be assessed by a specialist within 24 hours.

Guidelines state that, however, patients with low-risk TIA do not require immediate assessment, and can be assessed by a specialist within one week of the TIA.