Dept of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
Dept of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
Int J Cardiol. 2021 Jun 15;333:167-173. doi: 10.1016/j.ijcard.2021.02.067. Epub 2021 Mar 1.
Syncope care is often fragmented and inefficient. Structuring syncope care through implementation of guidelines and Syncope Units has been shown to improve diagnostic yield, reduce costs and improve quality of life. We implemented the European Society of Cardiology (ESC) 2018 syncope guidelines at the Emergency Departments (ED) and established Syncope Units in five Dutch hospitals. We evaluated the implementation process by identifying factors that hinder ('barriers') and facilitate ('facilitators') the implementation.
We conducted, recorded and transcribed semi-structured interviews with 19 specialists and residents involved in syncope care from neurology, cardiology, internal medicine and emergency medicine. Two researchers independently classified the reported barriers and facilitators, according to the framework of qualitative research (Flottorp), which distinguished several separate fields ('levels'). Software package Atlas.ti was used for analysis. We identified 31 barriers and 22 facilitators. Most barriers occurred on the level of the individual health care professional (e.g. inexperienced residents having to work with the guideline at the ED) and the organizational context (e.g. specialists not relinquishing preceding procedures). Participants reported most facilitators at the level of innovation (e.g. structured work-flow at the ED). The multidisciplinary Syncope Unit was welcomed as useful solution to a perceived need in clinical practice.
Implementing ESC syncope guidelines at the ED and establishing Syncope Units facilitated a structured multidisciplinary work-up for syncope patients. Most identified barriers related to the individual health care professional and the organizational context. Future implementation of the multidisciplinary guideline should be tailored to address these barriers.
晕厥的护理常常是碎片化且效率低下的。通过实施指南和晕厥单元来规范晕厥护理，已被证明可以提高诊断效果、降低成本并改善生活质量。我们在五个荷兰医院的急诊科（ED）实施了欧洲心脏病学会（ESC）2018 年晕厥指南，并建立了晕厥单元。我们通过识别阻碍（“障碍”）和促进（“促进因素”）实施的因素来评估实施过程。
我们对参与神经科、心内科、内科和急诊医学晕厥护理的 19 名专家和住院医师进行了半结构化访谈、记录和转录。两名研究人员根据定性研究（Flottorp）的框架独立对报告的障碍和促进因素进行分类，该框架区分了几个单独的领域（“水平”）。我们使用 Atlas.ti 软件包进行分析。我们确定了 31 个障碍和 22 个促进因素。大多数障碍发生在医疗保健专业人员个人层面（例如，经验不足的住院医师必须在 ED 遵循指南）和组织背景（例如，专家不愿放弃先前的程序）。参与者在创新层面（例如，ED 的结构化工作流程）报告了大多数促进因素。多学科的晕厥单元作为临床实践中明显需求的有用解决方案而受到欢迎。
在 ED 实施 ESC 晕厥指南并建立晕厥单元有助于对晕厥患者进行结构化的多学科评估。大多数确定的障碍与医疗保健专业人员个人和组织背景有关。未来实施多学科指南应针对这些障碍进行调整。
