The objective of this career development plan and proposed research is to develop the principal investigator into an independent clinical investigator to improve the emergency care of syncope patients. Syncope, or transient loss of consciousness, is a common reason to seek emergency department (ED) care. It can be caused by serious cardiac disease but is often a result of a benign etiology. Despite decades of research in this area, there remains a huge variability in the clinical management of these patients. Hospitalization after a non-diagnostic ED evaluation has not been shown to benefit patients and may, in some cases, be harmful. This decision is often made without significant input from patients regarding their wishes or discussion of reasonable alternatives. Shared decision-making is a collaborative process in which patients and physicians make a health care decision together, taking into account the best available evidence and the patient's values and preferences. Shared decision-making is appropriate when more than one medically reasonable management options exists, as in out-patient versus in-patient management of low-risk syncope patients. Decision aids are tools designed to increase patient understanding of treatment options and possible outcomes. Another means to improve emergency syncope care is the application of dissemination and implementation strategies to increase the use of clinical interventions proven to benefit patients. This research proposal has the following three aims: 1) Pilot test and refine a decision aid (named SynDA) using input from patients and providers, 2) Evaluate the effects of using this decision aid in a randomized controlled trial, and 3) Conduct a dissemination and implementation project to identify quality gaps in emergency care and determine their casual factors through qualitative interviews. The results of this research have the potential to positively impact the 1 million patients who present to ED with syncope every year in the United States. The proposed activities will provide the principal investigator with knowledge and skills in the areas of clinical trials, qualitative methods, and dissemination and implementation science in order to develop, evaluate, and implement interventions to improve cardiovascular outcomes for ED syncope patients.
A transient loss of consciousness is responsible for over 1 million emergency department (ED) visits and $2.4 billion in hospital costs every year in the United States. Despite much research in this area, there remains huge variability in clinical management and inconsistent quality of care. Through the use of shared decision-making and implementation strategies, this mentored research plan has the potential to enhance patient care and improve clinical outcomes for ED syncope patients.
