Development of practice recommendations based on the Canadian Syncope Risk Score and identification of barriers and facilitators for implementation.

Autor: Hudek N; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Brehaut JC; Ottawa Hospital Research Institute, Ottawa, ON, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada., Rowe BH; Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB, Canada., Nguyen PA; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Ghaedi B; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Ishimwe AC; Ottawa Hospital Research Institute, Ottawa, ON, Canada., Fabian C; Department of Emergency Medicine, The Montfort Hospital, Ottawa, ON, Canada., Yan JW; Division of Emergency Medicine, Western University, London, ON, Canada., Sivilotti MLA; Departments of Emergency Medicine and Biomedical, and Molecular Sciences, Queen's University, Kingston, ON, Canada., Ohle R; Departments of Emergency Medicine, Health Science North, Sudbury, ON, Canada.; Health Sciences North Research Institute, Sudbury, ON, Canada., Le Sage N; Department of Family Medicine and Emergency Medicine, Université Laval Université Laval, and CHU de Québec-Université Laval Research Center, Québec, QC, Canada.; CHU de Québec-Université Laval Research Center, Québec, QC, Canada.; VITAM-Centre de recherche en santé durable, Québec, QC, Canada., Mercier E; Department of Family Medicine and Emergency Medicine, Université Laval Université Laval, and CHU de Québec-Université Laval Research Center, Québec, QC, Canada., Archambault PM; Departments of Family Medicine and Emergency Medicine and Anesthesiology and Intensive Care Medicine, Université Laval, Québec, QC, Canada.; Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada., Plourde M; Department of Family Medicine and Emergency Medicine, Université Laval Université Laval, and CHU de Québec-Université Laval Research Center, Québec, QC, Canada.; Department of Family Medicine and Emergency Medicine, CHU de Québec-Université Laval, Québec, QC, Canada., Davis P; Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada., McRae AD; Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada., Hegdekar M; Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada., Thiruganasambandamoorthy V; Ottawa Hospital Research Institute, Ottawa, ON, Canada. vthirug@ohri.ca.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. vthirug@ohri.ca.; Clinical Epidemiology Program-Emergency Medicine, Department of Emergency Medicine, Clinical Epidemiology Unit, The Ottawa Hospital Research Institute, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, F6K1Y 4E9, Canada. vthirug@ohri.ca.
Jazyk: angličtina
Zdroj: CJEM [CJEM] 2023 May; Vol. 25 (5), pp. 434-444. Date of Electronic Publication: 2023 Apr 14.
DOI: 10.1007/s43678-023-00498-y
Abstrakt: Background: Wide variations in emergency department (ED) syncope management exist. The Canadian Syncope Risk Score (CSRS) was developed to predict the probability of 30-day serious outcomes after ED disposition. Study objectives were to evaluate the acceptability of proposed CSRS practice recommendations among providers and patients, and identify barriers and facilitators for CSRS use to guide disposition decisions.
Methods: We conducted semi-structured interviews with 41 physicians involved in ED syncope and 35 ED patients with syncope. We used purposive sampling to ensure a variety of physician specialties and CSRS patient risk levels. Thematic analysis was completed by two independent coders with consensus meetings to resolve conflicts. Analysis proceeded in parallel with interviews until data saturation.
Results: The majority (97.6%; 40/41) of physicians agreed with discharge of low risk (CSRS ≤ 0) but opined that 'no follow up' changed to 'follow-up as needed'. Physicians indicated current practices do not align with the medium-risk recommendation to discharge patients with 15-day monitoring (CSRS = 1-3; due to lack of access to monitors and timely follow-up) and the high-risk recommendation (CSRS ≥ 4) to potentially discharge patients with 15-day monitoring. Physicians recommended brief hospitalization of high-risk patients due to patient safety concerns. Facilitators included the CSRS-based patient education and scores supporting their clinical gestalt. Patients reported receiving varying levels of information regarding syncope and post-ED care, were satisfied with care received and preferred less resource intensive options.
Conclusion: Our recommendations based on the study results were: discharge of low-risk patients with physician follow-up as needed; discharge of medium-risk patients with 15-day cardiac monitoring and brief hospitalization of high-risk patients with 15-day cardiac monitoring if discharged. Patients preferred less resource intensive options, in line with CSRS recommended care. Implementation should leverage identified facilitators (e.g., patient education) and address the barriers (e.g., monitor access) to improve ED syncope care.
(© 2023. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)
Databáze: MEDLINE
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