ORIGINAL ARTICLE Resource utilisation for syncope presenting to an acute hospital Emergency Department F. McCarthy • S. De Bhladraithe • C. Rice • C. G. McMahon • U. Geary • P. K. Plunkett • P. Crean • R. Murphy • B. Foley • N. Mulvihill • R. A. Kenny • C. J. Cunningham Received: 16 July 2009 / Accepted: 4 May 2010 / Published online: 15 June 2010 Ó Royal Academy of Medicine in Ireland 2010 Abstract Background Syncope is a common clinical problem accounting for up to 6% of hospital admissions. Little is known about resource utilisation for patients admitted for syncope management in Ireland. Aim To determine the utilisation of resources for patients admitted for syncope management. Methods Single centre observational case series of con- secutive adult patients presenting to an acute hospital Emergency Department with syncope over a 5-month period. Results Two-hundred and fourteen of 18,898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Mean length of stay was 6.9 days. Sixty-four of these admissions were deemed unnecessary by retrospec- tive review when compared to ESC guidelines. Eighty-five (77.3%) admitted patients had cardiac investigations and 56 (51%) had brain imaging performed. Conclusions Syncope places a large demand on over- stretched hospital resources. Most cases can be managed safely as an outpatient and to facilitate this, hospitals should develop outpatient Syncope Management Units. Keywords Syncope Á Emergency Department Á Resources Á Investigations Introduction Syncope is a common clinical problem with lifetime preva- lence reaching up to 40% [1, 2]. Syncope accounts for 1–3% of Emergency Department (ED) visits and up to 6% of hos- pitalisations [3–12]. Syncope has numerous potential causes ranging from benign to life threatening conditions [1, 13] and can pose a diagnostic challenge to physicians. An important issue in managing patients with syncope in the ED setting is deciding whether or not they need admission for further evaluation. This has implications not only from a diagnostic yield, but also can result in inappropriate utilisation of acute hospital resources. Medical resource utilisation in reaching a diagnosis has been shown to be substantial [14–16] and has resulted in development of guidelines and pathways [2, 17] which advise on indications for hospitalisation, rational use of investigations and treatment options. Despite these developments inappropriate hospitalisa- tion and unwarranted investigations place extra demand on scarce resources. Little is known on the use of over- stretched resources for patients presenting with syncope to acute hospital services in Ireland. We have recently shown that the development of an integrated care plan (ICP) for syncope management in the ED was associated with a significant increase in referrals to our outpatient syncope management unit [18]. We now present data looking at resource utilisation by patients with syncope presenting to the ED. F. McCarthy (&) Á S. De Bhladraithe Á C. Rice Á R. A. Kenny Á C. J. Cunningham Department of Medicine for the Elderly, St James’s Hospital, James’s Street, Dublin, Ireland e-mail: francesmcc@eircom.net C. G. McMahon Á U. Geary Á P. K. Plunkett Department of Emergency Medicine, St James’s Hospital, James’s Street, Dublin, Ireland P. Crean Á R. Murphy Á B. Foley Á N. Mulvihill Department of Cardiology, St James’s Hospital, James’s Street, Dublin, Ireland 123 Ir J Med Sci (2010) 179:551–555 DOI 10.1007/s11845-010-0497-z