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Citation
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Jusmanova K, Rice C, Bourke R, Lavan A, McMahon CG, Cunningham C, Kenny RA, Briggs R. QJM 2020; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode however, and therefore a relatively high risk of readmission.
AIM: To examine the impact of ED-FASS (Emergency Department Falls & Syncope Service) a dedicated specialist service embedded within an Emergency Department (ED), seeing patients of all ages with falls, syncope and dizziness.
DESIGN: Pre and post cohort study.
METHODS: Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April-July 2018 (pre-ED-FASS) inclusive and compared to April-July 2019 inclusive (post ED-FASS).
RESULTS: There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 (27% (453/1,676) vs. 34% (548/1,620); X2=18.0; p < 0.001), with a 20% reduction in admissions.The mean LOS for patients admitted in 2018 was 20.7 (95% CI 17.4-24.0) days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; p = 0.3294). This accounts for 11,344 bed days in the 2018 study period, and 8,299 bed days used after ED-FASS.There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1,620) to 16% (68/1,676) (X2=4.68; p = 0.030).
CONCLUSION: This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.
Language: en |