Development of a Novel Emergency Department Quality Measure to Reduce Very Low-Risk Syncope Hospitalizations.
Development of a Novel Emergency Department Quality Measure to Reduce Very Low-Risk Syncope Hospitalizations.
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DOI：
10.1016/j.annemergmed.2022.03.008
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发表时间：
2022-06
影响因子：
6.2
通讯作者：
Thiruganasambandamoorthy, Venkatesh
中科院分区：
文献类型：
--
作者：
Probst, Marc A.;Janke, Alexander T.;Haimovich, Adrian D.;Venkatesh, Arjun K.;Lin, Michelle P.;Kocher, Keith E.;Nemnom, Marie-Joe;Thiruganasambandamoorthy, Venkatesh
Emergency department (ED) evaluations for syncope are common, representing 1.3 million annual US visits and $2 billion in related hospitalizations. Despite evidence supporting risk stratification and outpatient management, variation in syncope hospitalization rates persist. We sought to develop a new quality measure for very low risk ED adult syncope patients that could be applied to administrative data. We developed this quality measure in two phases. First, we used an existing prospective, observational ED patient dataset to identify a very low-risk cohort with unexplained syncope using two variables: age<50 years and no history of heart disease. We then applied this to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential impact, assessing for hospital-level factors associated with hospitalization variation. Of the 8,647 adult patients in the prospective cohort, 3,292 patients (38%) fulfilled these two criteria: Age under 50 and no history of heart disease. Of these, 15 (0.46%) suffered a serious adverse event within 30 days. In the NEDS, there were an estimated 566,031 patients meeting these two criteria, of whom 15,507 (2.7%, 95% Confidence interval [CI]: 2.48%, 3.00%)) were hospitalized. We found substantial variation in hospitalizations rates for this very low-risk cohort, with a median rate of 1.7%, (range: 0–100%, interquartile range: 0–3.9%). Factors associated with increased hospitalization rates included yearly ED volume >80,000 (Odds Ratio [OR]: 3.14, 95% CI: 2.02 to 4.89) and metropolitan teaching status (OR: 1.5, 95% CI: 1.24 to 1.81). In sum, our novel syncope quality measure can assess variation in low-value hospitalizations for unexplained syncope. Application of this measure could improve the value of syncope care.
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DOI：
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发表时间：
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