Evidence-based algorithms and the management of falls and syncope presenting to acute medical services

Falls and syncope are symptoms that commonly present to medical services. Detailed international guidelines for their management are available but tend to be aimed at specialists rather than generalists. Novel, evidence-based algorithms for the management of these symptoms when they present to acute medical services were formulated and their impact on patient care audited. The percentage of people admitted with falls and syncope was unexpectedly high (10.6% at baseline); this had decreased to 8.2% at repeat audit. Readmission rates decreased from 12% at baseline audit to 0% in repeat audit, while length of inpatient stay was unchanged. Mortality was strikingly high (12%) in both audits. Although inappropriate use of investigations decreased, the use of appropriate management strategies increased. Easy-to-use algorithms can help reduce the number of patients admitted to acute medical services with falls and syncope while optimising the care of those managed as inpatients. The algorithms are provided for use by interested parties.