JMIR Publications

ABSTRACT

Background:

Stroke remains a leading cause of disability in Canada, with approximately one-quarter of events preceded by a transient ischemic attack (TIA). Patients presenting with transient ischemic attack (TIA) or stroke in the emergency department (ED) or developing symptoms in acute non-stroke units are commonly admitted to stroke units for interdisciplinary assessment and discharge planning. However, the absence of integrated interdisciplinary stroke assessments in the ED and acute care settings has contributed to congestion, prolonged hospital length of stay, and delayed discharge. Although prior models have emphasized rapid outpatient TIA or stroke prevention clinics and ED observation pathways, these approaches have largely focused on expedited medical diagnostics and treatment, with limited attention to coordinated interdisciplinary functional assessment and discharge planning to reduce readmissions and support rehabilitation.

Objective:

This quality improvement protocol describes the implementation of the Mobile TIA and Stroke with AdaptiVE workflow (MOTIVE) team, an interdisciplinary mobile service comprising stroke neurologists, an advanced practice physiotherapist, an occupational therapist, a speech–language pathologist, a reactivation worker, and a stroke nurse. The team delivers timely medical and functional assessments across the ED and inpatient units to support early decision making and discharge planning.

Methods:

The MOTIVE project is guided by the established quality improvement methodology of the Institute for Healthcare Improvement, including Plan–Do–Study–Act cycles, process mapping, driver diagrams, and structured measurement strategies. Implementation will occur in phased stages over two years, focusing on assessing discharge readiness and streamlining referrals to rehabilitation services and the Stroke Prevention Clinic.

Results:

The primary outcomes included ED admission rates, hospital length of stay, and 30-day readmission rates. Secondary outcomes included patient satisfaction and healthcare cost reduction.

Conclusions:

: The MOTIVE initiative aims to improve stroke care delivery and system efficiency through an interdisciplinary, mobile, and cross-sector model tailored to the needs of patients in Northern Ontario. Clinical Trial: This innovative quality improvement protocol was registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/2JYBU).