SHM Converge Scientific Abstract ePoster Gallery-Syncope: Strategic Yield in Navigating Care Optimization and Patient Entry, a Learning Health System Approach

Pdf Summary

This project used a Learning Health System approach to reduce low-value hospital admissions for syncope in the emergency department.<br /><br />A multidisciplinary learning community was formed, including ED and internal medicine physicians and nurses, administrative leaders, and quality improvement specialists. The team first identified diagnoses with frequent potentially avoidable admissions, defined as discharges within 18 hours, and chose syncope as the focus. They then explored barriers to discharging low-risk patients and selected a de-implementation strategy: a clinical decision support “nudge.” After comparing available risk tools, the group chose the Canadian Syncope Risk Score (CSRS). The tool was user-tested and refined for usability and acceptability before implementation.<br /><br />In 2023, 1,714 patients presented to the ED with syncope or a related diagnosis, and 808 (47%) were admitted. Of the admitted patients, 196 (24%) had a CSRS score of 0, indicating low risk and a recommendation against admission. These low-risk admitted patients had an average inpatient stay of 70 hours, with only 9 patients (4.5%) returning to the ED within 2 weeks. The projected impact of discharging all low-risk syncope patients from the ED was substantial, including 572 inpatient bed-days saved and about $1,000,000 in associated costs avoided.<br /><br />The authors conclude that the Learning Health System framework is well suited for de-implementing low-value care. Their stakeholder-driven, systematic process produced a high-impact solution and showed that co-design with key stakeholders can support successful adoption. Future work will evaluate the prospective impact of the CSRS tool in routine ED workflow.

Asset Subtitle

Ruby Marr

Meta Tag

Author List Heidi O'Neill, Jen Sheets, Megan Mack, Olivia DeTroyer-Cooley, Peter England, Ruby Marr, Stephanie Taylor

Category Research

Concept Learning Health System

Concept Avoidable Hospital Admission

Concept Syncope

Concept Canadian Syncope Risk Score

Concept Low-Value Care

Distinguished Non-Finalist

Presenter Organization University of Michigan Medical School

Presenting Author Ruby Marr

Track Quality Improvement

Keywords

Learning Health System

syncope

emergency department

low-value care

hospital admissions

de-implementation

clinical decision support

Canadian Syncope Risk Score

quality improvement

stakeholder co-design

Learning Health System

Avoidable Hospital Admission

Syncope

Canadian Syncope Risk Score

Low-Value Care