Format

Send to

Choose Destination
See comment in PubMed Commons below
Ann Emerg Med. 2014 Aug;64(2):167-75. doi: 10.1016/j.annemergmed.2013.10.029. Epub 2013 Nov 13.

Randomized clinical trial of an emergency department observation syncope protocol versus routine inpatient admission.

Author information

1
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. Electronic address: sunb@ohsu.edu.
2
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
3
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
4
Department of Emergency Medicine, Duke University Medical Center, Durham, NC.
5
Department of Emergency Medicine, University of Southern California, Los Angeles, CA.
6
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI.
7
RAND Corporation, Santa Monica, CA.
8
College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL.
9
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.

Abstract

STUDY OBJECTIVE:

Older adults are frequently hospitalized from the emergency department (ED) after an episode of unexplained syncope. Current admission patterns are costly, with little evidence of benefit. We hypothesize that an ED observation syncope protocol will reduce resource use without adversely affecting patient-oriented outcomes.

METHODS:

This randomized trial at 5 EDs compared an ED observation syncope protocol to inpatient admission for intermediate-risk adults (≥50 years) presenting with syncope or near syncope. Primary outcomes included inpatient admission rate and length of stay. Secondary outcomes included 30-day and 6-month serious outcomes after hospital discharge, index and 30-day hospital costs, 30-day quality-of-life scores, and 30-day patient satisfaction.

RESULTS:

Study staff randomized 124 patients. Observation resulted in a lower inpatient admission rate (15% versus 92%; 95% confidence interval [CI] difference -88% to -66%) and shorter hospital length of stay (29 versus 47 hours; 95% CI difference -28 to -8). Serious outcome rates after hospital discharge were similar for observation versus admission at 30 days (3% versus 0%; 95% CI difference -1% to 8%) and 6 months (8% versus 10%; 95% CI difference -13% to 9%). Index hospital costs in the observation group were $629 (95% CI difference -$1,376 to -$56) lower than in the admission group. There were no differences in 30-day quality-of-life scores or in patient satisfaction.

CONCLUSION:

An ED observation syncope protocol reduced the primary outcomes of admission rate and hospital length of stay. Analyses of secondary outcomes suggest reduction in index hospital costs, with no difference in safety events, quality of life, or patient satisfaction. Our findings suggest that an ED observation syncope protocol can be replicated and safely reduce resource use.

PMID:
24239341
PMCID:
PMC4019722
DOI:
10.1016/j.annemergmed.2013.10.029
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center