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.

Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals / Brignole, M; Ungar, A; Bartoletti, A; Ponassi, I; Lagi, A; Mussi, Chiara; Ribani, Ma; Tava, G; Disertori, M; Quartieri, F; Alboni, P; Raviele, A; Ammirati, F; Scivales, A; De Santo, T.. - In: EUROPACE. - ISSN 1099-5129. - STAMPA. - 8:(2006), pp. 644-650.

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

MUSSI, Chiara;
2006

Abstract

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.
8
644
650
Standardized-care pathway vs. usual management of syncope patients presenting as emergencies at general hospitals / Brignole, M; Ungar, A; Bartoletti, A; Ponassi, I; Lagi, A; Mussi, Chiara; Ribani, Ma; Tava, G; Disertori, M; Quartieri, F; Alboni, P; Raviele, A; Ammirati, F; Scivales, A; De Santo, T.. - In: EUROPACE. - ISSN 1099-5129. - STAMPA. - 8:(2006), pp. 644-650.
Brignole, M; Ungar, A; Bartoletti, A; Ponassi, I; Lagi, A; Mussi, Chiara; Ribani, Ma; Tava, G; Disertori, M; Quartieri, F; Alboni, P; Raviele, A; Ammirati, F; Scivales, A; De Santo, T.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/612759
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