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1023 Improving diagnosis and appropriate specialty referral with a syncope pathway
  1. Richard Biggers1,
  2. Aidan McIvor2,
  3. Matthew J Reed2,
  4. Ishwinder Thethy2,
  5. Martyna Wojtowicz3
  1. 1St John’s Hospital Livingston and Western General Edinburgh
  2. 2Royal Infirmary of Edinburgh
  3. 3University of Edinburgh


Aims/Objectives/Background Syncope is a common presentation to ED. Patients with an underlying cardiac cause have increased risk of adverse outcome. Initially, aetiology can be unclear leading to high admission rates and associated costs. In August 2018, a syncope pathway was introduced at the Royal Infirmary of Edinburgh (RIE) ED to aid diagnosis and direct patients to appropriate services. Our aim was to assess the impact of this pathway on syncope diagnosis, admission rates, patient outcomes and specialty input.

Methods/Design A search of electronic patient records (EPR) eight months before and after the pathway’s introduction was conducted to identify patients presenting with ‘fainting episode +/- loss of consciousness’. EPR’s were reviewed and non-syncopal presentations excluded. Two reviewers consecutively sampled from both groups. Remaining patients had their EPR’s scrutinised to determine history, examination findings, immediate and 1-year outcomes and referrals to specialties.

Results/Conclusions Our search identified 1055 pre-pathway and 1073 post-pathway patients. Following exclusion of non-syncopal diagnoses, 673 patients remained in the pre-pathway group and 480 in the post-pathway group. Consecutive sampling from these groups generated 199 patients pre-pathway and 102 patients post-pathway with a median age of 65 (range 13–100).

A greater proportion of patients were admitted or referred to outpatient services following the pathway’s introduction (46.1% versus 30.2%). Of these, 25.5% were referred to outpatient clinics compared to 20% pre-pathway. Of those admitted, 77.1% received specialty input related to their syncope compared to 25% in the pre-pathway group. After 1-year follow-up, 8.8% of patients had alternative diagnoses for their syncope compared to 2.5% pre-pathway. Post pathway, there were two syncope related deaths – both situational syncope causing falls.

Following the introduction of our syncope pathway there was no significant reduction in unscheduled care admissions. However, we have seen more specialty input and improved diagnosis with importantly, no significant increase in syncope related deaths.

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