Welland

Syncope, a sudden temporary loss of consciousness, often leads patients to visit emergency departments (EDs). While many cases are harmless, some have serious heart-related or other causes that may not be obvious during initial ED assessment. Researchers have developed the Canadian Syncope Risk Score (CSRS) to help identify which patients need further tests, monitoring, or hospital admission. This study evaluates how well implementing CSRS-based recommendations in Canadian EDs improves patient safety and reduces unnecessary hospitalizations and ED stay times through a large, multi-center stepped wedge cluster randomized trial. The study involves 16 ED clusters across Canada split into two groups, each participating over 16 months. All sites start with usual care for three months, then gradually adopt the CSRS intervention in random order every three months until all have implemented it. The CSRS-based practice recommendations include thorough clinical evaluation, testing like troponin or CT scans as needed, using the CSRS to assess risk at the end of the ED visit, providing patient information materials, and providing 15-day outpatient heart monitoring for medium and high-risk patients. Emergency physicians will apply all these components during patient care. Participants are adults over 18 who arrive at the ED within 24 hours of a syncope episode. Researchers will measure hospital admission rates around the time of ED disposition, ED length of stay, and use of investigations. They will also assess physician adoption of the CSRS, patient safety outcomes over 30 days and one year including serious events, repeat ED visits, hospitalizations, and mortality. The study includes a transition period for implementation and ongoing monitoring of how well the CSRS recommendations are maintained after adoption.