Syncope Decision Aid for Emergency Care
Syncope Decision Aid for Emergency Care
Syncope, or transient loss of consciousness/fainting, is a common emergency department (ED)
 complaint responsible for over 1 million ED visits yearly. Potential causes include benign
 conditions such as dehydration or vaso-vagal syncope. Rarely, syncope is the result of
 serious cardiac conditions. In older patients without a clear cause of syncope hospital
 admission is frequently initiated at very low risk thresholds, though there is little
 evidence that these admissions improve patient outcomes. These decisions are often made
 without significant patient input or discussion of reasonable alternatives. In this
 situation, a patient's values, preferences, and particular circumstances should be taken into
 account. This mutualistic approach to clinical management is referred to as Shared
 Decision-Making. Shared Decision-Making (SDM) is a joint process of choice selection between
 providers and patients in clinical scenarios where multiple reasonable management options
 exist. To improve syncope emergency care, the researchers can leverage recent advances in
 risk stratification to engage patients in SDM and deliver superior, patient-centered care.

 This study will provide the groundwork for a larger, randomized controlled trial evaluating
 the effects of the decision aid for management of low-risk syncope.
Setting:

 Mount Sinai Hospital (MSH) has a 61-bed adult Emergency Department with a volume of over
 100,000 patient visits/year or approximately 300 visits/day. MSH is a large academic tertiary
 care medical center located in East Harlem and serves a large black and Hispanic community.

 Projected Recruitment: There are approximately 60 MSH ED visits for syncope per month of
 which 35 per month are by patients above age 30. Roughly half of these do not have a clear
 etiology of their syncope discovered in the ED. The researchers project that of the 17
 potentially eligible patients per month, three will be successfully enrolled for a projected
 72 patient enrollees at the completion of the 24-month recruitment period. The PI, clinical
 research coordinators, and SRAs will monitor the real-time electronic tracking system for all
 ED patients and will identify any patient over age 30 with a chief complaint of syncope or
 loss of consciousness.
Inclusion Criteria:

 -  Emergency Department patient

 -  Age 30 years or above

 -  Chief complaint of syncope

 -  Capacity to make medical decisions

 -  Speak and read English

 -  Working phone number and fixed address

 Exclusion Criteria:

 -  Altered Mental Status

 -  Cognitive Impairment

 -  Serious acute diagnosis:

 (e.g. clinically significant cardiac dysrhythmia, structural heart disease,
 gastrointestinal hemorrhage, myocardial infarction, pulmonary embolism, pneumonia,
 arterial dissection, serious infection, ectopic pregnancy, subarachnoid hemorrhage, or
 stroke.)

 -  Hemodynamic instability

 -  Inability to read or speak English

 -  Major communication barrier

 -  Lack of phone number or fixed address

 -  Too high risk as per physician judgment