A Systematic Emergency Department Care Protocol for Syncope Patients Reduces Admissions.

Here, we report outcomes for a quality-improvement initiative intended to reduce unnecessary admissions and testing using a novel decision aid for emergency department (ED) patients with syncope. The decision aid was developed through literature review and working group sessions of emergency physicians, hospitalists, and cardiologists at the University of North Carolina Medical Center (Figure 1). A standardized initial evaluation was suggested with targeted testing recommendations based on initial findings. Patients with an unclear etiology of syncope were stratified based on high-risk features derived from existing guidelines. Those with high-risk features were considered for admission, whereas those without high-risk features were recommended for discharge. Expedited evaluation in an outpatient syncope clinic by advanced practice providers with supervision by a cardiologist was available for low-risk patients. Use of the decision aid was nonmandatory, but providers received education on the protocol through multiple channels and were offered active feedback on compliance.