Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals.
OBJECTIVE
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.


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).


CONCLUSIONS
A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.
Brignole
Michele
M
Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via don Bobbio 24, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it
Ungar
Andrea
A
Bartoletti
Angelo
A
Ponassi
Irene
I
Lagi
Alfonso
A
Mussi
Chiara
C
Ribani
Maria Angela
MA
Tava
Gianni
G
Disertori
Marcello
M
Quartieri
Fabio
F
Alboni
Paolo
P
Raviele
Antonio
A
Ammirati
Fabrizio
F
Scivales
Alessandro
A
De Santo
Tiziana
T
D000368:Aged; D000369:Aged, 80 and over; D003659:Decision Making, Organizational; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000592:standards; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis / Q000191:economics / Q000628:therapy*