Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments.
10.3349/ymj.2013.54.5.1110
- Author:
Tae Gun SHIN
1
;
June Soo KIM
;
Hyoung Gon SONG
;
Ik Joon JO
;
Min Seob SIM
;
Seung Jung PARK
Author Information
1. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Syncope;
diagnosis;
education;
costs and cost analysis
- MeSH:
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
- From:Yonsei Medical Journal
2013;54(5):1110-1118
- CountryRepublic of Korea
- Language:English
-
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.
