title: Management of syncope in the Emergency Department: a single hospital observational case series based on the application of European Society of Cardiology Guidelines.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of introducing a European Society of Cardiology guideline-based Integrated Care Plan (ICP) for Syncope on hospital admissions and referral patterns to an outpatient Syncope Management Unit, of patients presenting to an Emergency Department (ED) with a syncopal episode and to determine the underlying causes of syncope.
  
  
  RESULTS
  This study is a single-centre observational case series of consecutive adult patients presenting to the ED over a 5-month period. Two hundred and fourteen of 18 898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Forty-six (41.8%) admissions were indicated by the ICP. All potential cardiac syncope cases were admitted. There was a 500% increase in the overall number of referrals to the Syncope Management Unit with a small increase in the number of unnecessary referrals.
  
  
  CONCLUSIONS
  The introduction of an ICP for syncope was not associated with any cases with potential adverse outcomes being lost to follow-up and resulted in increased referral rates to the syncope unit. However, hospitalization rates for syncope remain high, and a large number of patients requiring early outpatient assessment were not referred. There remains a need to develop further interventions to guide appropriate and safe syncope management in the ED.
authors.affiliation: Department of Medicine for the Elderly, St James's Hospital, St James's Street, Dublin, Ireland. francesmcc@eircom.net
authors.forename: Frances
authors.initials: F
authors.lastname: McCarthy
authors.forename: C Geraldine
authors.initials: CG
authors.lastname: McMahon
authors.forename: Una
authors.initials: U
authors.lastname: Geary
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Plunkett
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
authors.forename: Conal J
authors.initials: CJ
authors.lastname: Cunningham
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012955:Societies, Medical; D013575:Syncope / Q000628:therapy*