Standardized approaches to syncope evaluation for reducing hospital admissions and costs in overcrowded emergency departments

• Published in: Yonsei medical journal 2013, 54(5), , pp.1110-1118
• Main Authors: Shin, Tae Gun, Kim, June Soo, Song, Hyoung Gon, Jo, Ik Joon, Sim, Min Seob, Park, Seung-Jung
• Format: Article
• Language: English
• Subjects: Adult; Aged; Costs and Cost Analysis; Crowding; Emergency Medical Services - methods; Emergency Medical Services - standards; Emergency Service, Hospital; Female; Hospitalization; Humans; Male; Middle Aged; Observation; Original; Prospective Studies; Syncope - diagnosis; 의학일반
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2013.54.5.1110

The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January- December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea.