Objectives and Background The Emergency Department (ED) of Medway Maritime Hospital recorded a patient census of 82 000 in 2007 and 87 000 in 2010. Syncope/Collapse/Falls are regular presentations with published mortality rates of 10%–15% and up to 30% for general and cardiac-related causes respectively. A Syncope Proforma and improved educational lectures were introduced in 2008 to improve the management of these patients following a retrospective audit in 2007. An electronic Syncope Proforma was available from 2009 with further modifications in 2010. We conducted a re-audit in 2010 to evaluate the impact of these changes on patients' care.

Method The ED records of patients presenting with Syncope/Collapse/Falls from October 2010 to January 2011 were compared with the January 2007 group. Both were classified using the ACP Syncope Clinical groupings of High, Intermediate, and Low Risk. Patients with trauma, assault, seizures, or substance / alcohol misuse were excluded.

Result The majority were female (54%) in 2007 and male (58%) in 2010. Cardiac, Musculoskeletal and Neurological conditions accounted for the majority. In-appropriate discharges from High and Intermediate Risk Groups were unremarkable (33% vs 31% & 42% vs 47% respectively) but inappropriate admissions in the Low Risk Groups improved (43% vs 29%). The lack of a cohesive hospital-wide policy, poor hospital bed management, admitting team refusals, poor risk recognition and documentation, poor community and social support, and the impact of performance service targets all weaken departmental initiatives to improve patient care.

Conclusion The ED Syncope Proforma and NICE guidelines failed to improve overall quality of care. The successful management of Syncope/Collapse/Falls requires a hospital-wide operational approach to care and not the sole responsibility for an ED.