Can a Specialty Service Help Reduce Hospital Admission Rates in Patients with Unexplained Syncope?
Date First Published:
November 29, 2025
Last Updated:
November 29, 2025
Report by:
Bradley Buska MD, Nathanial Ladaga DO, Senior EM resident, EM Faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, Research Director
Three-Part Question:
In [adults with primary presentation of syncope] is a [targeted multidisciplinary approach] more effective than [general workup] in [reducing hospital admission rates]?
Clinical Scenario:
A 77-year-old female with a history of type 2 diabetes, hypertension, and paroxysmal atrial flutter presents to the emergency department after syncope and collapse. She was walking in her home when she began to feel lightheaded and was unable to reach the counter before losing consciousness. She has not missed any medications, and the initial workup in the emergency department did not identify an apparent cause of syncope. The treating ED clinician arranges admission for cardiac monitoring and observation. He wonders if a specialist service might reduce hospital admissions as well as adverse events.
Search Strategy:
Medline 1966-10/25 using PubMed, Cochrane Library (2025), and Embase
Search Details:
[(Syncope [MeSH]) AND (Emergency Service, Hospital [MeSH]) AND (hospital admission)]. Limit to English language and adults.
[(Syncope [MeSH]) AND (Emergency Service, Hospital [MeSH]) AND (specialist service)]. Limit to English language and adults.
[(Syncope [MeSH]) AND (Emergency Service, Hospital [MeSH]) AND (specialist service)]. Limit to English language and adults.
Outcome:
42 articles were identified, two answered the clinical question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness Jusmanova K, Rice C, Bourke R, et al. February 2021 Ireland | 663 patients presenting to the ED with syncope | Cohort study to determine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED seeing patients with syncope. |
Admission rates, length of stay (LOS) and readmission at 3 months before and after using the ED-FASS within the ED. | There was a significantly lower admission rate for patients (20%) evaluated by ED-FASS (P < 0.001). Readmissions were decreased from 21% to 16% (P = 0.030) and the mean LOS for admitted patients was reduced by 2.5 days (P = 0.3294). | Data collection was retrospective, it was a single-center study, and most patients seen in the ED did not require specialist testing in the syncope unit in order to ascertain a diagnosis and make a management plan |
| Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management Shen WK, Decker WW, Smars PA, et al. December 2004 USA | 103 ED patients who presented with syncope of undetermined cause and who had intermediate risk for an adverse cardiovascular outcome | RCT randomly allocating patients to two treatment arms: syncope unit evaluation and standard care | Diagnostic yield and hospital admission rate; length of hospital stay; all-cause mortality and recurrent syncope during follow-up | For the syncope unit and standard care patients, the presumptive | Unblinded study design. Confounding factors such as the patient’s preference for inpatient or outpatient evaluation and the physician’s effort to make the diagnosis in the emergency department could be influenced by the randomization. A large number of patients declined to participate in the study. The absence of cost-benefit analysis was a major limitation. |
| diagnosis was established in 34 (67%) and 5 (10%) patients (P<0.001), respectively. Hospital admission was required for 22 (43%) and 51 (98%) patients (P< 0.001) respectively. Total patient-hospital days were reduced from 140 to 64. Actuarial survival was 97% and 90% (P=0.30), and survival free from recurrent syncope was 88% and 89% (P=0.72) at 2 years for the syncope unit and standard care groups, respectively. |
Author Commentary:
There is a high degree of variability in practice patterns, diagnostic yields, and lengths of hospital stay for patients with syncope in the emergency department. An appropriate and efficacious syncope management pathway remains far from established. Subsequently, many are discharged without a precise diagnosis for their index episode. These studies provide two effective management options for syncope patients in the ED: 1) A designated syncope unit in an emergency department for the evaluation of patients with intermediate-risk profiles where multidisciplinary collaboration provided efficient and effective evaluation and triage of patients; and 2) ED-FASS embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.
Bottom Line:
A multidisciplinary specialist service based in the ED offers several benefits in the management of syncope patients, including early specialist assessment and directing appropriate patients to effective ambulatory care pathways decreasing hospitalization.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Jusmanova K, Rice C, Bourke R, et al.. Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness
- Shen WK, Decker WW, Smars PA, et al.. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management