• Jing Li, Vedant Gupta, Susan S Smyth, Amy Cowley, Gaixin Du, Matthew Sirrine, Seth Stearley, Romil Chadha, Vikas Bhalla, and Mark V Williams.
• Center for Health Services Research, Department of Medicine, University of Kentucky, Lexington, KY, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington, KY, USA. Electronic address: jingli.tj@uky.edu.
• Am J Emerg Med. 2020 Sep 1; 38 (9): 1867-1874.

BackgroundSyncope is a common condition seen in the emergency department. Given the multitude of etiologies, research exists on the evaluation and management of syncope. Yet, physicians' approach to patients with syncope is variable and often not value based. The 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope includes a focus on unnecessary medical testing. However, little research assesses implementation of the guidelines.MethodsMixed methods approach was applied. The targeted provider specialties include emergency medicine, hospital medicine and cardiology. The Evidence-based Practice Attitude Scale-36 and the Organizational Readiness to Change Assessment surveys were distributed to four different hospital sites. We then conducted focus groups and key informant interviews to obtain more information about clinicians' perceptions to guideline-based practice and barriers/facilitators to implementation. Descriptive statistics and bivariate analyses were used for survey analysis. Two-stage coding was used to identify themes with NVivo.ResultsAnalysis of surveys revealed that overall attitude toward evidence-based practices was moderate and implementation of new guidelines were seen as a burden, potentially decreasing compliance. There were differences across hospital settings. Five common themes emerged from interviews: uncertainty of a syncope diagnosis, rise of consumerism in health care, communication challenge with patient, provider differences in standardized care, and organizational processes to change.ConclusionsDespite recommendations for the use of syncope guidelines, adherence is suboptimal. Overcoming barriers to use will require a paradigm shift. A multifaceted approach and collaborative relationships are needed to adhere to the Guidelines to improve patient care and operational efficiency.Copyright © 2020 Elsevier Inc. All rights reserved.

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