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Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals.
- Source :
-
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2006 Aug; Vol. 8 (8), pp. 644-50. - Publication Year :
- 2006
-
Abstract
- Aims: The study hypothesis was that a decision-making approach improves diagnostic yield and reduces resource consumption for patients with syncope who present as emergencies at general hospitals.<br />Methods and Results: This was a prospective, controlled, multi-centre study. Patients referred from 5 November to 7 December 2001 were managed according to usual practice, whereas those referred from 4 October to 5 November 2004 were managed according to a standardized-care pathway in strict adherence to the recommendations of the guidelines of the European Society of Cardiology. In order to maximize its application, a decision-making guideline-based software was used and trained core medical personnel were designated-both locally in each hospital and centrally-to verify adherence to the diagnostic pathway and give advice on its correct application. The 'usual-care' group comprised 929 patients and the 'standardized-care' group 745 patients. The baseline characteristics of the two study populations were similar. At the end of the evaluation, the standardized-care group was seen to have a lower hospitalization rate (39 vs. 47%, P=0.001), shorter in-hospital stay (7.2+/-5.7 vs. 8.1+/-5.9 days, P=0.04), and fewer tests performed per patient (median 2.6 vs. 3.4, P=0.001) than the usual-care group. More standardized-care patients had a diagnosis of neurally mediated (65 vs. 46%, P=0.001) and orthostatic syncope (10 vs. 6%, P=0.002), whereas fewer had a diagnosis of pseudo-syncope (6 vs. 13%, P=0.001) or unexplained syncope (5 vs. 20%, P=0.001). The mean cost per patient and the mean cost per diagnosis were 19 and 29% lower in the standardized-care group (P=0.001).<br />Conclusion: A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.
- Subjects :
- Aged
Aged, 80 and over
Emergency Service, Hospital economics
Female
Hospital Costs
Humans
Male
Middle Aged
Practice Patterns, Physicians' economics
Practice Patterns, Physicians' statistics & numerical data
Prospective Studies
Syncope diagnosis
Syncope economics
Decision Making, Organizational
Emergency Service, Hospital standards
Guideline Adherence economics
Guideline Adherence standards
Practice Guidelines as Topic standards
Syncope therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1099-5129
- Volume :
- 8
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 16864618
- Full Text :
- https://doi.org/10.1093/europace/eul071