Intensive Education on Evidence-Based Evaluation of Syncope Increases Sudden Death Risk Stratification but Fails to Reduce Use of Neuroimaging

Abstract

With intensive education, there was no decrease in neuroimaging, despite a low diagnostic yield. We were able to increase sudden death risk stratification using electrophysiologic studies without evidence of overuse of implantable device-based therapy. Intensive education allows increased adherence to guidelines for mortality reduction; however, further attempts to reduce the lower yield imaging will require methods other than education of hospital-based physicians.

Standardized Approaches to Syncope Evaluation for Reducing Hospital Admissions and Costs in Overcrowded Emergency Departments

“…Education alone may be insufficient to modify physician behavior, as local hospital education programs often do not lead to notable changes in the evaluation of syncope 9,23. We hypothesized that a simple, organized approach would help to overcome this barrier.…”

“…The evaluation of syncope is often not standardized and ineffective 9,10. Despite the recent publication of guidelines regarding appropriate and structured evaluation of syncope,2,11,12 these guidelines have not been widely disseminated and are sometimes difficult to apply in clinical practice 9,13.…”

“…Despite the recent publication of guidelines regarding appropriate and structured evaluation of syncope,2,11,12 these guidelines have not been widely disseminated and are sometimes difficult to apply in clinical practice 9,13. Even hospital-based education may be insufficient to ensure optimal evaluation.…”

Educational Initiatives for Quality Improvement Projects

“…8 More recent studies, performed at major academic medical centers, continue to demonstrate the relative lack of efficacy of rather simple educational interventions. 10,11 A study by Sclafani and colleagues 11 is particularly illustrative. In this study, a didactic intervention that included lectures and printed material was performed at an academic military institution targeted to achieve a reduction in neuroimaging studies in patients presenting with syncope.…”

Point-of-care decision support for reducing inappropriate test use: easier said than done

“…In an effort to both understand the drivers of the growth of cardiovascular imaging and to help curb unnecessary use of these tests, the American College of Cardiology Foundation developed Appropriate Use Criteria (AUC),3 which now apply to all cardiac imaging modalities, including echocardiography. Despite the availability of such documents, the uptake and utilisation of AUC remains modest at best, and educational efforts alone have largely proven unsuccessful 4 5. Consequently, attempts have been made to implement AUC using a variety of active methods, including decision support tools.…”