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Standardized Care Pathway Versus Conventional Approach in the Management of Patients Presenting with Faint at the University of Utah

Authors


  • Disclosures: M. Brignole and M.H. Hamdan are the co-inventors of the software described in this article (Faint Algorithm, F2 Solutions, Sandy, UT). They have financial interest in the start-up company that has exclusive rights to the software product.

Address for reprints: Mohamed H. Hamdan, M.D., M.B.A., Professor of Medicine, Chief, Division of Cardiovascular Medicine, University of Wisconsin, H4/534 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3248. Fax: 608-265-2011; e-mail: mhamdan@medicine.wisc.edu

Abstract

Background

Despite the availability of guidelines, the evaluation of patients with faint continues to be inconsistent. The purpose of this study was to test the hypothesis that utilization of a new standardized-care pathway (Faint-Algorithm) reduces hospital admissions and improves diagnostic yield when compared to the conventional approach in the evaluation of patients with faint.

Methods

We reviewed the data of 154 consecutive patients presenting with faint to the Faint and Fall Clinic at the University of Utah (standardized group) and 100 patients previously evaluated for faint using the conventional approach (conventional group).

Results

Using a standardized approach, only 4% of patients were admitted when compared to 20% in the conventional group (P < 0.001). The rate of diagnosis at initial evaluation was similar between the groups; however, at 45 days, it was greater in the standardized group when compared to the conventional group (57% vs 45% in the total population, P = 0.09; 57% vs 39% in the outpatient subgroups, P = 0.02). The number of tests or consultations associated with additional charges was significantly lower in the standardized group when compared to the conventional group (1.9 ± 1.0 vs 2.6 ± 1.2, P = 0.001).

Conclusions

The use of a standardized approach in the evaluation of patients with faint decreased the number of hospital admissions and increased the rate of diagnosis at 45 days. This was achieved with less utilization of costly tests and consultations.

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