A multidisciplinary care pathway for the evaluation of falls and syncope in geriatric patients

Wold, J.F.H.; Ruiter, Jaap H.; Cornel, Jan H.; Vogels, Raymond L.C.; Jansen, René W. M. M.

doi:10.1016/j.eurger.2015.05.007

Cited by 14 publications

(8 citation statements)

References 20 publications

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“…A multidisciplinary care pathway, based on current guidelines of syncope and falls, has already been developed to evaluate unexplained non-accidental falls and/or syncope in geriatric patients [11]. Indeed, the management of falls and syncope in a geriatric population is challenging, because in up to 60% of the cases a witness account is not available and about 35% of the patients are left without a good explanation for their syncope.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

et al. 2018

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Purpose To evaluate the characteristics of patients referred for dizziness to a Syncope Unit. Methods This is a retrospective study. Of 491 patients referred to the Syncope Unit of Careggi Hospital in 2015, 198 (40.3%) who experienced dizziness alone or associated with a history of transient loss of consciousness were enrolled. All the patients underwent an initial evaluation according to the European Society of Cardiology guidelines on syncope. We compared the clinical characteristics and final diagnosis of patients referred for dizziness alone (n = 64) to those of patients with dizziness and history of transient loss of consciousness (n = 134). Results The study population had a mean age of 62 ± 20 years (range 16-96 years) and 101 (51%) were female. A final diagnosis of pre-syncope was made in about the 80% of the patients without a previous history of transient loss of consciousness. In this group, other diagnoses were benign paroxysmal positional vertigo (6.3%), transient ischemic attack (4.7%) or psychogenic dizziness (7.8%). Syncope was diagnosed in the 82.7% of the patients with dizziness and history of transient loss of consciousness. Conclusion Dizziness was the main reason for referral to the Syncope Unit in almost one-third of the patients, in whom presyncope was the most frequent final diagnosis. Otological, neurological and psychiatric disorders should be also considered as differential diagnosis, highlighting the importance of a multidisciplinary approach.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

et al. 2018

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“…The majority of patients also undergo a 24 h Holter registration. The details and outcomes of this two-day program have been published earlier [6,19,20]. The ethical board concluded that the study could be exempted because this study uses archival data of standard geriatric evaluations, and had no implications on therapeutic decisions.…”

Section: Methodsmentioning

confidence: 99%

Atrial Fibrillation, Anticoagulation, and Major Bleeding Episodes in Geriatric Patients at the Risk of Falling

Zwart¹,

Germans²,

Şimşek³

et al. 2019

obm geriatr

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Background: Geriatric patients are at risk of atrial fibrillation (AF) and stroke, and the risk of oral anticoagulation (OAC) related bleeding is also presumed to be higher. Detailed knowledge about the prevalence of AF and bleeding pattern in this population is scarce. This study sought to assess the prevalence of AF, use of OAC, and the rate of major bleeding in geriatric patients who are prone to frequent falls. We expect to find a higher prevalence of AF among geriatric patients compared to elderly people of comparable age. Methods: This was an observational cohort study conducted at the Fall and Syncope Clinic. Inclusion criteria: age >65 years, availability of both electrocardiogram (ECG) and Holter registration. The use and reasons to withhold OAC and the rate of major bleeding were retrieved from the medical files. Results: A total of 428 patients with the mean age of 79.8 years were analyzed. The mean number of morbidities was 11 ±5. AF was known in 98 (23%) patients, first diagnosed in 10 (2%). Among them, AF was paroxysmal in 45 (45%) patients, and 50% of them were first diagnosed cases. Of patients with AF, 84% were using OAC. The rate of major bleeding episodes was 1.1 per 100 treatment years. Major bleeding episodes were not different between the patients using antiplatelet agents (APA), OAC, or no antithrombotic medication. Conclusions: In this geriatric population, 23% of patients had AF and almost half were paroxysmal. Compared to previous studies, the use of OAC has substantially increased to 84% and no differences were found in the rate of major bleeding episodes between those using APA, OAC, or no antithrombotic medication.

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“…Care pathway implementation and its continuous improvement increase the quality of care, while reducing the time period for the diagnostic pathway and preventing investigations (Wold et al. , 2015).…”

Section: Literature On Lean Six Sigma In Stroke Pathwaymentioning

confidence: 99%

“…Literature on lean six sigma in stroke pathway Care pathway implementation and its continuous improvement increase the quality of care, while reducing the time period for the diagnostic pathway and preventing investigations (Wold et al, 2015). Timely patient treatment at the ED should be prioritized to guarantee the effectiveness of care, while avoiding delays, suboptimal outcomes and dissatisfied patients (Perry, 2019).…”

Section: Introductionmentioning

confidence: 99%

Lean six sigma and stroke in rural hospital – The case of Baruch Padeh Medical Center

Tzadok

Tov

Vaispapir

et al. 2022

IJHCQA

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PurposeThis case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy.Design/methodology/approachThe LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define–Measure–Analyze–Improve–Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway.FindingsThe presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min.Originality/valueThe present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.

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A multidisciplinary care pathway for the evaluation of falls and syncope in geriatric patients

Cited by 14 publications

References 20 publications

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

Retrospective analysis of patients with dizziness evaluated in Syncope Unit: a real life experience

Atrial Fibrillation, Anticoagulation, and Major Bleeding Episodes in Geriatric Patients at the Risk of Falling

Lean six sigma and stroke in rural hospital – The case of Baruch Padeh Medical Center

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