Abstract

AimsSyncope care is often fragmented and inefficient. Structuring syncope care through implementation of guidelines and Syncope Units has been shown to improve diagnostic yield, reduce costs and improve quality of life. We implemented the European Society of Cardiology (ESC) 2018 syncope guidelines at the Emergency Departments (ED) and established Syncope Units in five Dutch hospitals. We evaluated the implementation process by identifying factors that hinder (‘barriers’) and facilitate (‘facilitators’) the implementation. Methods and resultsWe conducted, recorded and transcribed semi-structured interviews with 19 specialists and residents involved in syncope care from neurology, cardiology, internal medicine and emergency medicine. Two researchers independently classified the reported barriers and facilitators, according to the framework of qualitative research (Flottorp), which distinguished several separate fields (‘levels’). Software package Atlas.ti was used for analysis.We identified 31 barriers and 22 facilitators. Most barriers occurred on the level of the individual health care professional (e.g. inexperienced residents having to work with the guideline at the ED) and the organizational context (e.g. specialists not relinquishing preceding procedures). Participants reported most facilitators at the level of innovation (e.g. structured work-flow at the ED). The multidisciplinary Syncope Unit was welcomed as useful solution to a perceived need in clinical practice. ConclusionImplementing ESC syncope guidelines at the ED and establishing Syncope Units facilitated a structured multidisciplinary work-up for syncope patients. Most identified barriers related to the individual health care professional and the organizational context. Future implementation of the multidisciplinary guideline should be tailored to address these barriers.

Highlights

  • Syncope is the form of transient loss of consciousness (TLOC) that is due to global cerebral hypoperfusion; it is characterized by a rapid onset, short duration and complete and spontaneous recovery [1].⁎ Corresponding author at: Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands.Syncope is a very common problem which accounts for ~1% of all visits to the Emergency department (ED) and is associated with high healthcare costs [1,2]

  • Medical specialists preferred to adhere to older established routines which were not in line with the European Society of Cardiology (ESC) SG, which caused a barrier to adapt to the new guideline

  • We systematically evaluated the factors influencing the implementation of the European Society of Cardiology Syncope Guidelines (ESC SG) at the ED and Syncope Units and identified various barriers and facilitators providing several new insights

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Summary

Introduction

Syncope is the form of transient loss of consciousness (TLOC) that is due to global cerebral hypoperfusion; it is characterized by a rapid onset, short duration and complete and spontaneous recovery [1]. ⁎ Corresponding author at: Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands. Syncope is a very common problem which accounts for ~1% of all visits to the Emergency department (ED) and is associated with high healthcare costs [1,2]. The differential diagnosis is broad, and the causes of syncope range from benign to life-threatening conditions. Recurrent syncope significantly impacts quality of life (QoL) [3] and can be improved through effective diagnosis and treatment [1]. Where applicable quantitative data were presented as mean ± SD for continuous variables with a normal distribution and as medians with interquartile range for data that were not normally distributed

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