Hawkesbury

Syncope, a sudden loss of consciousness, often leads to emergency department ED visits. While many cases are harmless, some are caused by serious heart or other medical problems that might not be clear during the initial ED visit. Researchers have developed the Canadian Syncope Risk Score CSRS to help identify patients who need further tests, monitoring, or hospital admission. This study tests how well the CSRS-based recommendations work in real-world ED settings to improve patient safety and reduce unnecessary hospital stays and ED waiting times. This study involves 16 emergency departments across Canada in a stepped wedge cluster randomized trial lasting 16 months per batch. Initially, all EDs use their usual care for three months, then gradually switch to using the CSRS-based recommendations in random order, with two EDs changing every three months. The CSRS approach includes careful clinical evaluation, use of specific tests like troponin or CT scans, risk assessment at the end of the ED visit, providing patient information, and arranging 15-day outpatient heart monitoring for medium and high-risk patients. ED doctors apply these steps during patient care. Participants include adults who come to the ED within 24 hours after a syncope episode. Researchers will measure hospitalization rates, time spent in the ED before disposition, death rates up to one year, return ED visits, and how well doctors adopt and follow the CSRS recommendations. Data will be collected throughout the trial to assess both healthcare efficiency and patient safety. The study will last until 2026, with ongoing monitoring of outcomes and processes.