Methods: This descriptive study was a retrospective chart analysis of 684 asymptomatic TIA patients admitted to the EDOU, over a 20-month period. Patients were divided by significant or no significant findings for either brain or neck MRA or both.Results: There were no significant findings for either the brain or neck MRA in 70.8% (n¼484) of patients. 9.8% (n¼67) had significant findings for only the neck MRA. 12.0% (n¼82) of patients had significant findings for only the brain MRA. 7.5% (n¼51) had significant findings for both brain and neck MRA. Significant findings included moderate to severe vascular stenosis and/or occlusion of the vertebral arteries, carotid, aneurysms (saccular and fusiform), subclavian steal syndrome, and thyroid nodules. Clinically significant findings were noted in 29.4% of the 684 patients.Conclusion: With the use of MRA of the brain and neck, we are discovering more clinically significant findings that may have gone years undiagnosed. Based on this data, it seems fitting that the use of MRI of the brain with MRA of the brain and neck should be utilized for evaluation of TIA patients when able, thus replacing prior workups such as, carotid ultrasound.

Background To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies used by a large community hospital located in Barrie, Ontario to manage COVID-19. Methods Guided by a qualitative descriptive approach, we conducted a thematic analysis of all COVID-19-related documentation discussed by the hospital’s Emergency Operations Centre (EOC) during the first pandemic wave. We solicited operational strategies from administrative leaders to construct a narrative for each theme. Results Seven recurrent themes critical to the hospital’s pandemic response emerged: 1) Organizational Structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity Planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational Health and Workplace Safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human Resources/Workforce Planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal Protective Equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community Response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate Communication: a robust communication strategy provided timely and transparent access to rapidly evolving information. Conclusions The hospital benefited from an interconnected command structure that focused on inter-operability, communication, novel administrative tools, and community partnerships.