International Award for Wirral University Teaching Hospital doctor
A Trust consultant at Wirral University Teaching Hospital (WUTH) has been recognised with an international award for his work in transforming services for syncope patients.
Syncope is the medical term for fainting and Dr Mehran Asgari, Trust Consultant Cardiologist at WUTH has been recognised with an Excellence Award from STARS – the Syncope Trust and Reflex Anoxic Seizures Organisation.
As a global problem, Syncope will affect 1 in five of us during our lifetime. The causes behind a faint that brings a patient into hospital are many. Standing up too quickly when you have low blood pressure; being too hot, really angry, upset or in pain, could all result in us passing out.
Although not usually a sign of something serious, the temporary loss of consciousness could be a symptom of something more serious such as a heart condition. Patients, especially when their faint resulted in an injury, can find themselves in the Emergency Department and then spend some time on a ward, while multiple tests are carried out to try to determine the reason they passed out.
The phrase ‘just a simple faint’ is something many of us will have heard, but to Dr Asgari and many of his colleagues who see patients with syncope, there is no such thing as a simple faint. Between 5% and 7% of the Emergency Department attendances at WUTH could be coded as syncope, which is around 3,500 to 5,000 patients in just one year.
Dr Asgari has spent time in Italy with the leading syncope expert Professor Michele Brignole and his team gaining an understanding of how patients who present with this condition are managed there. In 2018, he was one of the authors of a retrospective study¹ which showed that despite extensive tests, around two thirds of patients who came into hospital with syncope were discharged with no diagnosis. So potentially at WUTH, more than 3,000 patients were being admitted to hospital, when other options would better.
Dr Asgari recognised the need to develop guidelines in order to effectively manage the syncope patients and brought together a multidisciplinary team, to collaborate on the development of a Syncope Service and guidelines. The aim of the team, which included colleagues from the Emergency Department, Acute Medicine, Stroke, Cardiology and Primary Care, was to produce a clear pathway for emergency departments and general practitioner referrals, which would lead to patients being more appropriately investigated, managed and referred.
Since the introduction of the Syncope Guidelines and dedicated service, multi-specialty referrals have been avoided and there has been a reduction in the number of unnecessary test requests as well as bed occupancy. However, Dr Asgari believes there is no room for complacency as there is certainly more work to be done in terms of education and training.
According to Dr Asgari: “When a patient comes into hospital, it is crucial to start with a detailed history of the circumstances surrounding their fainting episode. Early evidence shows that this is helping to identify patients who can safely be discharged on the same day, for follow up in a dedicated syncope clinic. The Syncope Guidelines as well as the referral pathway will simplify the process of diagnosis and management for the doctors involved. Moreover, the application of the guidelines is helping the ‘patient flow’ in the face of increased pressure on hospital beds.”
Recently, Dr Asgari’s expertise has been recognised with the Excellence Award from STARS. This international award recognises his work in introducing Syncope Guidelines and the setting up of a dedicated Syncope Service at the Trust.
Dr Nikki Stevenson, Executive Medical Director, Deputy CEO and Consultant Respiratory Physician at WUTH said: “I’d like to congratulate Dr Asgari for this Excellence Award, which recognises his outstanding work. This benefits both patients, by preventing unnecessary hospital stays and diagnostic tests, and the Trust by saving resources that can be used on other frontline services.”