Abstract 9728: A Novel Emergency Department Syncope Protocol Reduces Unnecessary Hospital Admissions

Abstract

Background: More than 1.2 million emergency department (ED) visits for syncope occur each year in the US. Many associated admissions and diagnostic studies may be unnecessary. Objective: To determine the effectiveness of a novel protocol for syncope care in the ED in reducing unnecessary admissions and diagnostic testing. Methods: A multi-disciplinary team developed a decision aid for ED syncope management guided by focused history, physical, and diagnostic testing. Clear indications for diagnostic testing were laid out in the protocol and incorporated into the ED workflow through education and medical record system integration. Patients considered safe for discharge were provided an expedited appointment in a specialty clinic. Rates of admission, utilization of diagnostic studies (head CT, carotid ultrasound, echocardiogram), and rates of return presentation to the ED within 30 days were compared before and after implementation. Results: Between September 2019 and December 2019, 308 syncope patients presented to the ED. Between January 2020 and June 2020 (following implementation), 321 syncope patients presented to the ED. The proportion admitted decreased (44.6% to 30.0%, p<0.001. Figure), while the proportion undergoing diagnostic studies was unchanged (19.5% to 16.0%, p=0.303). The proportion returning to the ED within thirty days was unchanged (11.2% to 10.2%, p=0.769). The proportion referred for expedited follow up to a syncope specialty clinic increased (1.5% to 8.8%, p<0.001). Conclusion: Implementation of an ED syncope care pathway with utilization of a syncope specialty clinic was associated with significantly reduced hospital admissions. Utilization of diagnostic testing and rates of return ED presentation within thirty days were unchanged. Additional studies to evaluate the scalability and cost benefits of this program are warranted.