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

Europace. 2006 Aug;8(8):644-50. doi: 10.1093/europace/eul071.


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.

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).

Conclusion: A standardized-care pathway significantly improved diagnostic yield and reduced hospital admissions, resource consumption, and overall costs.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Decision Making, Organizational*
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / standards*
  • Female
  • Guideline Adherence* / economics
  • Guideline Adherence* / standards
  • Hospital Costs
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic / standards*
  • Practice Patterns, Physicians' / economics
  • Practice Patterns, Physicians' / statistics & numerical data
  • Prospective Studies
  • Syncope / diagnosis
  • Syncope / economics
  • Syncope / therapy*