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lüll 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 C; Ribani MA; Tava G; Disertori M; Quartieri F; Alboni P; Raviele A; Ammirati F; Scivales A; De Santo TEuropace 2006[Aug]; 8 (8): 644-50AIMS: 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.|*Decision Making, Organizational[MESH]|*Guideline Adherence/economics/standards[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Emergency Service, Hospital/economics/*standards[MESH]|Female[MESH]|Hospital Costs[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Practice Guidelines as Topic/*standards[MESH]|Practice Patterns, Physicians'/economics/statistics & numerical data[MESH]|Prospective Studies[MESH]|Syncope/diagnosis/economics/*therapy[MESH] |