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Implementation of the Canadian syncope pathway: a pilot non-randomized stepped wedge trial.

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  • 1Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. vthirug@ohri.ca.

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Summary

The Canadian Syncope Pathway (CSP) pilot study successfully met most benchmarks for emergency department syncope management, demonstrating high adoption and fidelity. Further optimization of patient reach is needed for multicenter implementation.

Keywords:
Canadian syncope pathwayCanadian syncope risk scorePilot implementationRisk-stratificationSyncope

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Area of Science:

  • Emergency Medicine
  • Clinical Pathways
  • Health Services Research

Background:

  • The Canadian Syncope Pathway (CSP) and Canadian Syncope Risk Score (CSRS) were developed to standardize emergency department (ED) syncope management.
  • A pilot study was conducted to assess the feasibility of implementing the CSP in a real-world clinical setting.

Purpose of the Study:

  • To evaluate patient inclusion, transition period length, and process measures (engagement, reach, adoption, fidelity) of the CSP.
  • To prepare for multicenter implementation of the CSP in EDs.

Main Methods:

  • A 7-month non-randomized stepped wedge trial was conducted at two hospitals.
  • Physicians and patients (≥18 years) with syncope were included.
  • Process measures and patient characteristics were analyzed during the intervention period.

Main Results:

  • 1002 eligible patients were included.
  • Adoption rates reached 84.4%, and fidelity remained high (83.3%).
  • Patient reach was 55.0%, falling short of the 60% target.

Conclusions:

  • The pilot study achieved most benchmarks for multicenter CSP implementation, except for patient reach.
  • A 1-month transition period appears adequate, but regular reminders will be necessary for sustained implementation.