Abstract
IntroductionIn an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative. Prior studies have shown admission rates for syncope in the United States to be as high as 70%. However, the safety and utility of substituting ED observation unit (EDOU) syncope management has not been well studied. The objective of this study was to evaluate the safety of EDOU for the management of patients presenting to the ED with syncope and its efficacy in reducing hospital admissions.MethodsThis was a prospective before-and-after cohort study of consecutive patients presenting with syncope who were seen in an urban ED and were either admitted to the hospital, discharged, or placed in the EDOU. We first performed an observation study of syncope management and then implemented an ED observation-based management pathway. We identified critical interventions and 30-day outcomes. We compared proportions of admissions and adverse events rates with a chi-squared or Fisher’s exact test.ResultsIn the “before” phase, 570 patients were enrolled, with 334 (59%) admitted and 27 (5%) placed in the EDOU; 3% of patients discharged from the ED had critical interventions within 30 days and 10% returned. After the management pathway was introduced, 489 patients were enrolled; 34% (p<0.001) of pathway patients were admitted while 20% were placed in the EDOU; 3% (p=0.99) of discharged patients had critical interventions at 30 days and 3% returned (p=0.001).ConclusionA focused syncope management pathway effectively reduces hospital admissions and adverse events following discharge and returns to the ED.
Highlights
In an age of increasing scrutiny of each hospital admission, emergency department (ED) observation has been identified as a low-cost alternative
In the “before” phase, 570 patients were enrolled, with 334 (59%) admitted and 27 (5%) placed in the ED observation unit (EDOU); 3% of patients discharged from the ED had critical interventions within 30 days and 10% returned
After the management pathway was introduced, 489 patients were enrolled; 34% (p
Summary
Prior studies have shown admission rates for syncope in the United States (U.S.) to be as high as 70%, triggering at least 2% of hospital admissions from the emergency department (ED) and 460,000 hospitalizations annually.[1,2,3] emergency medicine has become more adept at distinguishing high-risk syncope from syncope of benign etiology and safety in ED discharge, there is a paucity of data addressing the care of patients once the ED recognizes a need for admission or further management.[4,5,6,7,8,9,10,11,12,13,14,15,16,17] Recent data note that a typical hospital admission in the U.S for syncope averages $5,300 with a total cost of syncope-related admissions of over. The objective of this study was to evaluate the utility and safety of an ED observation-based management pathway for the evaluation of patients presenting to the ED following a syncopal event
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