Validation and Implementation of the Canadian Syncope Risk Scale for Risk-Stratification of Syncope Patients in the Emergency Department
Syncope (commonly known as fainting) is a common condition that affects one-third of the population at least once during their lifetime. Among those who suffer syncope, one-third will suffer it repeatedly.
Syncope can be caused by serious underlying conditions such as irregular heart rhythm or blood clots in the lung. Some of these serious conditions will lead to death if not properly identified and treated. However, the majority (90%) who suffer syncope do not have any serious underlying conditions.
Because of the dramatic nature of the condition, two-thirds of all syncope patients will arrive to the hospital by ambulance; we estimate that annually 100,000 patients visit the Emergency Department (ED) because of syncope. One-third of all patients with serious underlying conditions will not be identified during the ED visit because there are no clear guidelines as to how syncope patients should be managed in the ED. There is also no research on diverting the very low-risk patients to alternate pathways of care either by patient self-assessment or after evaluation by ambulance personnel. Half of all patients who are admitted to the hospital are admitted for suspicion of cardiac abnormality such as irregular heart rhythm. These patients can potentially avoid being admitted with the use of new remote monitoring technology. Ultimately, the whole management of syncope patients from the community to the ED needs to be standardized and redesigned.
This program will redesign syncope care from the community to the ED by:
1) Developing a digital application for patients to self-assess their risk to decide on further course of action (go to ED now or follow-up later with a physician)
2) Developing a risk-tool for ambulance personnel to identify the very low-risk patients who can be diverted away from the ED for follow-up later with a physician (we will establish syncope clinics for urgent follow-up)
3) Developing an accurate risk-stratification strategy for ED physicians to standardize and help in management of syncope patients; and reduce hospitalizations by developing a remote ECG monitoring strategy for those at-risk for arrhythmias.
We anticipate that this program will improve syncope care at all levels: at the community level through the patient self-assessment tool, at the pre-hospital (paramedic) level by the tool developed for ambulance personnel, and at the hospital level through tools and remote cardiac monitoring strategy developed for the physicians caring for syncope patients.
- Decrease suffering and death due to syncope by accurately identifying at-risk patients.
- Reduce health care costs by decreasing low-risk syncope patient visits to the ED
- Decrease ambulance workload by diverting low-risk patients
- Improve patient satisfaction by reducing ED wait times
- Empower patients by teaching them how to self-manage recurrent episodes of syncope
- Use technology (remote ECG monitoring; digital applications) in a way that will lead to industrial development and job creation
The program will include 5 projects. Each of the projects and the risk-tools will progress through a continuum of: innovative idea to address the problem, confirm the innovation (risk-tool) works; apply the tool or the developed innovation in various setting (cities, towns and rural areas) to ensure that it works and assess the benefits; and finally disseminate the innovation across the country and the world.
- We have already developed a risk tool for identification of patients with serious conditions in the emergency (Canadian Syncope Risk Score). We will validate and implement the tool to assess the accuracy and health economic benefits of the tool.
- We will develop the out-of-hospital monitoring protocol by ensuring it is safe; it works and then implement it.
- We will develop, test and implement the risk tool for use by ambulance personnel to divert low-risk syncope patients.
- We will develop, test and implement the risk tool for patient self-management.
- We will disseminate all the tools by digital application development.
We have secured the collaboration of professional organizations, provincial health agencies, and national and international non-profit organizations to aid in dissemination.
Dr. Venkatesh Thiruganasambandamoorthy
University of Ottawa