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

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.