STARS Healthcare Pioneers Report

Showcasing Best Practice In Syncope

Introduction of the syncope guidelines and setting up a dedicated syncope service in a University Teaching Hospital NHS Trust

Dr Mehran Asgari MD
Wirral University Teaching Hospital NHS Foundation Trust, Merseyside, UK

Introduction

Syncope is the cause of non-traumatic Transient Loss of Consciousness (TLoC) that is typically characterised by its short duration, abnormal motor control, loss of responsiveness and amnesia for the period of TLoC. It is a global problem with an estimated lifetime incidence of 20%. It can often pose a significant diagnostic and management challenge to the physician.

Admission rates vary between 28% to 76% in some studies. We recognised that no structured guideline was being applied to the patients presenting with syncope in Wirral University Teaching Hospital NHS Foundation Trust,which serves a population of around 333,000, with annual ED (emergency department) admission rate of 75,784 in 2017-18. A retrospective study confirmed the clear evidence of delay to the diagnosis, prolonged inpatient stays, unnecessary and often costly investigations.

Aims

We therefore set up a working group including specialists in ED, Acute Medicine, Stroke, Cardiology and Primary Care to write the first syncope guidelines for the Trust. We reviewed the syncope management programs in several centres including UK, North America and Italy. We also set up a dedicated outpatient syncope clinic to see the non-urgent cases upon discharge from ED.

Service description

After several meetings with various stakeholders, the first syncope guidelines for the Trust finally became available on the hospital intranet. Red flag features which require patient admission are clearly defi ned for the physicians in the guidelines. When the patient is found to be safe to discharge – mostly on the same day, a simple syncope referral pathway is filled in and the completed form is sent to the “syncope expert” who will in turn facilitate the relevant outpatient investigations and timely patient follow up in a dedicated syncope clinic.

Syncope management can be complex and thus education of the physicians has been found to be inadequate. We have been therefore organising regular educational meetings, including “The North West STARS Syncope Symposium” with the target audiences of specialist doctors, nurses and other healthcare professionals.

As we are currently auditing the new service, short term results in terms of avoiding multi-specialty referrals, and reduction in the number of unnecessary test requests become apparent. We feel that the front line doctors are seeing syncope patients with more confidence now.

Application of the syncope guidelines is helping to identify patients for a safe discharge without the need for prolonged stay. This has certainly helped the “patient flow” whilst we face increased pressure on hospital beds.

Introduction of the syncope guidelines and setting up a dedicated syncope service in a University Teaching Hospital NHS Trust

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