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Audio file transcript: Virtual or in-person – a look at TIA clinics

Thank you for you listening to the audio to support our poster on virtual or in-person – a look at TIA clinics. My name is Sarah Brown and I am the project manager for this evaluation.

Virtual outpatient clinics (where most appointments and consultations are completed remotely) were widely introduced during the COVID-19 pandemic. Most NHS trusts moved to this model of care for TIA clinics to minimise face-to-face contact between health care professionals and patients. Some services have continued with a virtual model of care, others have returned to face-to-face clinics or now offer a hybrid approach. there is a limited evidence base for the effectiveness, of the virtual model or the experience of patients and staff. To address this we carried out an 18-month real-world evaluation which included mapping the different care pathways in 14 clinics (interviewing 15 patients and 12 healthcare professionals).

There were two main findings: Firstly, wide variation across services, even when using the same model. This meant it wasn’t possible to define what a good pathway looks like for each model. Secondly, pathways and working practices were primarily dependent on imaging availability, particularly for MRI.

Benefits of the virtual model for patients included time-saving due to reductions in travel and appointments. Healthcare professionals had greater flexibility to manage TIA services around other clinical demands and patients made quicker progress.

Challenges of the virtual model included a lack of clear patient facing information. Some patients and healthcare professionals found it more difficult to build a rapport and patients told us they had fewer opportunities to ask questions, particularly when given a diagnosis of TIA and its significance.

Why is this important?

Delivering high quality rapid access TIA services is important to reduce the burden of recurrent stroke through early treatment. We have four key recommendations:

  • Firstly, develop a framework to set common standards for TIA outpatients clinics, including when virtual consultations are appropriate and or preferred.
  • Secondly, develop and implement an improved referral and triage system to help manage unpredictable demand through streamlining.
  • Thirdly, improve signposting and patient-facing information.
  • Finally, the hybrid model could offer benefits to patients and healthcare professionals, if the best aspects are adopted.

In summary:

  • There is potential to use virtual consultation for some patients. Developing a framework for commissioners and services to support service design is key – and patient input essential. We will work with the GIRFT Stroke team and the ISDNs to support these changes.
  • Thanks the funder – the Accelerated Access Collaborative at NHS England, with support from the National Institute for Health and Care Research. And to the PPI project members with lived experience of TIA, patients, carers and healthcare professionals who participated in the project.
  • Thank you for listening to this overview. If you have any questions or would like more details on the project please email