An Innovative Model of Stroke Care for Rapid Assessment and Discharge of Patients With Transient Ischemic Attack and Stroke in Northeastern Ontario: Protocol for the Implementation and Evaluation of MOTIVE (Mobile Transient Ischemic Attack and Stroke With Adaptive Workflow) Team.

backgroundPatients presenting to the emergency department (ED) with transient ischemic attack (TIA) or stroke, as well as admitted patients who develop stroke symptoms in acute nonstroke units, are commonly transferred to stroke units, where trained interdisciplinary teams provide comprehensive assessments and discharge planning. However, the lack of integrated interdisciplinary stroke assessments in the ED and acute nonstroke unit care settings has contributed to inefficient patient flow and capacity pressure, prolonged hospital length of stay (LOS), and delayed discharge. Prior models have emphasized rapid outpatient TIA or stroke prevention clinics and ED observation pathways; these approaches have largely focused on expedited medical diagnosis and treatment, with limited attention to coordinated interdisciplinary functional assessment and discharge planning to facilitate early discharge, especially from the ED and nonstroke units, reduce readmissions, and support rehabilitation.

objectiveThis protocol outlines the implementation and prospective evaluation of the MOTIVE (Mobile Transient Ischemic Attack and Stroke With Adaptive Workflow) team, an interdisciplinary mobile service operational within the ED and inpatient nonstroke units at Health Sciences North, a regional stroke center in Northeastern Ontario. The service aims to deliver prompt medical and functional assessments to facilitate early decision-making and discharge planning. The objectives are to (1) reduce avoidable ED admissions for patients with TIA and minor stroke, (2) decrease hospital LOS, (3) maintain patient safety as measured by 30-day readmission rates, and (4) enhance patient and caregiver experience.

methodsThis single-center, prospective, uncontrolled, before-and-after quality improvement study will use control charts to evaluate temporal changes in outcomes. The MOTIVE project will follow the Institute for Healthcare Improvement Model for Improvement and will be reported in accordance with the SQUIRE (Standards for Quality Improvement Reporting Excellence) 2.0 guidelines. The preimplementation period (fiscal year 2022) will serve as the baseline period. The postimplementation evaluation will cover 12 months following the full implementation of the MOTIVE team, with iterative refinement guided by Plan-Do-Study-Act cycles.

resultsThis is a study protocol; therefore, the results are not yet available. Planned analyses will include run charts and control charts to evaluate temporal trends, alongside preimplementation and postimplementation comparisons. Outcomes will comprise primary measures (ED-to-inpatient admission rate, acute LOS, and avoided bed-day costs), process measures (time to interdisciplinary assessment, magnetic resonance imaging wait time, and proportion of patients triaged within 24 h), and balancing measures (30-day readmission, outpatient therapy services wait time, stroke prevention clinic referral volume and wait time, and patient and caregiver experience).

conclusionsThis innovative MOTIVE model is anticipated to improve stroke care efficiency, patient outcomes, and patient and caregiver experience through timely interdisciplinary assessments and support earlier discharge for select patients. The findings of this study will inform the feasibility and scalability of this model in similar health care contexts.

trial registrationOSF Registries osf.io/2jybu; https://osf.io/2jybu. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/93315.