title: Standardized approaches to syncope evaluation for reducing hospital admissions and costs in overcrowded emergency departments.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea.
authors.forename: Tae Gun
authors.initials: TG
authors.lastname: Shin
authors.forename: June Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyoung Gon
authors.initials: HG
authors.lastname: Song
authors.forename: Ik Joon
authors.initials: IJ
authors.lastname: Jo
authors.forename: Min Seob
authors.initials: MS
authors.lastname: Sim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003441:Crowding; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D013575:Syncope / Q000175:diagnosis*
keywords: Syncope; costs and cost analysis; diagnosis; education
references.citation: Europace. 2006 Aug;8(8):644-50
references.pmid: 16864618
references.citation: Minerva Med. 1998 Jun;89(6):211-20
references.pmid: 9739353
references.citation: Circulation. 2004 Dec 14;110(24):3636-45
references.pmid: 15536093
references.citation: Am J Cardiol. 2010 Jan 1;105(1):82-6
references.pmid: 20102895
references.citation: Mayo Clin Proc. 2008 Nov;83(11):1280-93
references.pmid: 18990328
references.citation: Crit Care Med. 2009 Mar;37(3):819-24
references.pmid: 19237883
references.citation: Europace. 2010 Jan;12(1):109-18
references.pmid: 19948566
references.citation: Circulation. 2006 Jan 17;113(2):316-27
references.pmid: 16418451
references.citation: Ann Emerg Med. 2007 Apr;49(4):431-44
references.pmid: 17371707
references.citation: Eur Heart J. 2004 Nov;25(22):2054-72
references.pmid: 15541843
references.citation: Eur Heart J. 2002 May;23(10):815-20
references.pmid: 12009722
references.citation: Chin Med J (Engl). 2010 Oct;123(19):2635-9
references.pmid: 21034644
references.citation: Am Heart J. 2005 May;149(5):826-31
references.pmid: 15894963
references.citation: Europace. 2005 Jul;7(4):400-6
references.pmid: 15944102
references.citation: Age Ageing. 2002 Jul;31(4):272-5
references.pmid: 12147565
references.citation: J Am Coll Cardiol. 2010 Feb 23;55(8):713-21
references.pmid: 20170806
references.citation: Ann Emerg Med. 2008 Jan;51(1):15-24, 24.e1-2
references.pmid: 17980458
references.citation: Can J Cardiol. 2011 Mar-Apr;27(2):246-53
references.pmid: 21459273
references.citation: Europace. 2010 Sep;12(9):1322-8
references.pmid: 20507854
references.citation: Pacing Clin Electrophysiol. 2011 Mar;34(3):284-90
references.pmid: 21091737
references.citation: Eur Heart J. 2009 Nov;30(21):2631-71
references.pmid: 19713422
references.citation: Arch Intern Med. 2010 Jul 12;170(13):1150-4
references.pmid: 20625024
references.citation: N Engl J Med. 2002 Sep 19;347(12):878-85
references.pmid: 12239256
references.citation: Am J Cardiol. 2005 Mar 1;95(5):668-71
references.pmid: 15721118
references.citation: Europace. 2008 Apr;10(4):471-6
references.pmid: 18364373
references.citation: Pacing Clin Electrophysiol. 2011 Mar;34(3):278-83
references.pmid: 21029127
references.citation: Eur Heart J. 2000 Jun;21(11):935-40
references.pmid: 10806018
references.citation: Ann Emerg Med. 2010 Oct;56(4):362-373.e1
references.pmid: 20868906