Introduction: We are currently validating the Canadian Syncope Risk Score (CSRS). Interim analysis shows that CSRS has excellent risk-stratification abilities. We are in the process of developing an implementation protocol.
Methods: Step 1: We would like to survey to understand the limitations and barriers of implementation and develop education materials. Step 2: We are planning to conduct a before-after study at xx hospitals (xx academic centers, xx non-academic large urban centers, and xx non-urban sites). Nine centers are currently enrolling patients in the validation phase (VGH; St. Bonafice – Winnipeg; 2 x LHSC; KGH, Hotel-Dieu; 2 x TOH; Quebec City). After the start of the validation phase, some of above sites had remote cardiac rhythm monitoring devices available for application if higher-risk patients are discharged from the ED (TOH, possibly Kingston sites, Quebec, and VGH). We have before data for these sites (both at the start of validation and remote monitoring availability). We will undertake an educational intervention regarding application of the CSRS tool and will also have remote cardiac rhythm monitoring devices available at all the study sites during implementation.
Outcomes: Primary: Proportion hospitalized, ED LOS. Secondary: SAE outside the hospital within 30-days, $$ saved. Sensitivity analysis will be performed to assess the contribution of the availability of remote monitoring devices in the ED.
Impact on EM: Reduce health care resource utilization, and also improve patient safety
Questions:
- Would you like to be a major collaborator or co-lead in Step 1?
- Based on the evidence that is presented from a clinical stand point, do you foresee any problems
- Non-Ottawa investigators: would you like to be part of the implementation (would have to work out with cardiology for the remote monitoring piece)