Multi-Centre Cluster-Randomized Implementation of Canadian Syncope Pathway for Emergency Department Syncope Management


Create the tools for delivering the best emergency department syncope care across the world


To provide physicians and patients the tools, information and knowledge to improve patient safety and optimize healthcare resource utilization

A multi-centre, stepped-wedge, cluster-randomized controlled trial. The goal of this study is to assess the effectiveness of the pathway’s implementation by enrolling 11,520 syncope patients over 16 months at 16 cluster hospitals on healthcare efficiency and patient safety. Our intervention includes local champions, robust education, easy online access to materials, and incorporation of the pathway into electronic health records. We will assess the effect on hospitalization, time to disposition decision from physician initial assessment, consultations in the ED, 30-day serious outcomes; 1-year deaths, cardiac device insertions, ED visits, and hospitalizations; and process measures such as reach, adoption, and adherence to the recommendations. We hope to reduce the hospitalizations by 5% (currently 20.1%) while improving patient safety.

About the Study

Study Objectives, Design, Timeline, and Participating sites

Contact Us

Contact information of Principal Investigators, Research Coordinator and Research Assistants at Coordinating Site


This tool is an online risk calculator for individualized risk prediction of 30-day risk for serious outcomes after discharge among patients presenting to the emergency department with syncope. The patient infographics can be used as an aid to discuss with patients to formulate a management plan.

CSRS Pathway

The Canadian Syncope Pathway provides practice recommendations based on the CSRS tool. If no serious condition is identified during the index ED evaluation, the pathway allows for immediate discharge of low-risk patients; consideration for brief hospitalization of high-risk patients and discharge of medium-risk patients with clear information about the serious outcome risk. Prolonged (15-day) outpatient cardiac monitoring is recommended for medium and high-risk patients who are discharged from the ED.


Downloadable List of Ethics Approvals, updated protocol, current study forms and more

Educational Material

Viewable and downloadable study videos, posters, slides, infographics and more