Abstract
PurposeThis study aims to evaluate whether a management algorithm has improved the effectiveness of care for dizzy patients at Umeå University Hospital.MethodsThis was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012–2014) and after (period 2, 2016–2017) the implementation of a management algorithm. Outcomes were changes in a set of pre-defined effectiveness markers and health economic effects.ResultsTotal n = 2126 and n = 1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix–Hallpike testing increased, 20.8% [95% confidence interval (CI) 18.8–23.0%] vs. 37.7% (95% CI 35.2–40.2%), as did BPPV diagnoses, 7.6% (95% CI 6.6–8.8%) vs. 15.3% (95% CI 13.6–17.3%). Hospitalization became less common, 61.5% (95% CI 59.4–63.6%) vs. 47.6% (95% CI 45.1–50.2%). The proportion undergoing any neuroradiological investigation decreased, 44.8% (95% CI 42.7–47.0%) vs. 36.3% (95% CI 33.8–38.7%) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.ConclusionsThis study shows that the implementation of a management algorithm for dizzy patients was associated with improved effectiveness of care.
Highlights
Dizziness and vertigo, hereafter termed “dizziness” for practical reasons, [1] are common symptoms presented by patients at emergency departments (EDs) [2]
To control for possible organizational changes influencing rates of hospitalization and length-of-stay we investigated the numbers of available hospital beds and the occupancy, as well as the mean and median lengths-of-stay for a control group not expected to change due to the effects of the management algorithm, i.e. headache (R51.9, G43.x and G44.x) patients, during the study duration
The costs per patient declined after the implementation of the management algorithm, from $2561 in period 1 to $1808 in period 2 (Table 3, outcome f). This single-center interventional study has shown that the implementation of a comprehensive management algorithm for dizzy patients at Umeå University Hospital was associated with improved effectiveness of care for this patient group
Summary
Hereafter termed “dizziness” for practical reasons, [1] are common symptoms presented by patients at emergency departments (EDs) [2]. A retrospective study at Umeå University Hospital covering 2012–14 showed that more than half of ED patients with dizziness remained undiagnosed despite an unusually high degree ( > 60%) of hospitalization; and that few underwent positional testing for the most common peripheral vestibular causes of dizziness [4]. These findings suggested that this hospital had much to gain from measures aiming at increasing the effectiveness of care for dizzy patients. The objectives of the present study were to investigate, compare and report any changes in the effectiveness of care, as defined below, for dizzy patients at Umeå University Hospital after the implementation of this management algorithm for dizziness
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