Implementing a Guideline to Improve Management of Syncope in the Emergency Department

Abstract

BACKGROUND AND OBJECTIVES: Thirty-five percent of children experience syncope at least once. Although the etiology of pediatric syncope is usually benign, many children undergo low-yield diagnostic testing. We conducted a quality improvement intervention to reduce the rates of low-yield diagnostic testing for children presenting to an emergency department (ED) with syncope or presyncope.METHODS: Children 8 to 22 years old presenting to a tertiary care pediatric ED with syncope or presyncope were included. We excluded children who were ill-appearing, had previously diagnosed cardiac or neurologic disease, ingestion, or trauma. We measured diagnostic testing rates among children presenting from July 2010 through October 2012, during which time we implemented a quality improvement intervention. Patient follow-up was performed 2 months after the ED visit to ascertain subsequent diagnostic testing and medical care.

The development and evaluation of an evidence-based guideline programme to improve care in a paediatric emergency department

“…We showed, using time series methodology, a decrease in resource utilisation (radiographs, viral testing and β-agonist therapy) for patients with bronchiolitis without a change in outcomes 29. In addition, we were able to decrease resource utilisation (blood testing and intravenous fluid) and increase rates of pregnancy testing in pubertal girls and ECG testing for patients with syncope 30. In a third publication demonstrating the effectiveness of the programme, we were able to decrease rates of brain imaging for patients with minor head injury, and at a rate faster than that of the national decline 31.…”

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

“…In the first example,61 the improvement team was unable to contact 56 patients for phone or email follow-up (ie, why the data are missing). To account for this missing data, the team performed serial reviews of medical records.…”

An Innovative Pilot Curriculum Training Pediatric Residents in Referral and Communication Skills on a Cardiology Rotation

“…Results of our study demonstrated a measurable short-term improvement in learners' performance similar to those of Guse et al, who showed improved use of diagnostic testing after a quality improvement intervention in syncopal patients. 12 In our project, the key components to achieve competence included interactive session with content expert, peer -peer discussions, and feedback from SPs.…”