Yonsei Med J.  2013 Sep;54(5):1110-1118. 10.3349/ymj.2013.54.5.1110.

Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments

• Shin TG
• Kim JS
• Song HG
• Jo IJ
• Sim MS
• Park SJ

• KMID: 1793157
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1110

Abstract

PURPOSE
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.
MATERIALS AND 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).
CONCLUSION
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.

Keyword

Syncope; diagnosis; education; costs and cost analysis

MeSH Terms

Adult
Aged
Costs and Cost Analysis
Crowding
Emergency Medical Services/methods/*standards
*Emergency Service, Hospital
Female
*Hospitalization
Humans
Male
Middle Aged
Observation
Prospective Studies
Syncope/*diagnosis

Figure

• 

  Fig. 1 Comparisons of hospital admission rates between the control and intervention groups.

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