MAGNITUDE OF THE PROBLEM

Faint is a generic term frequently used at the initial presentation of the patient, which encompasses all disorders characterized by transient, self-limited, non-traumatic loss of consciousness. A recent epidemiological study performed in the state of Utah, showed that the yearly incidence of Faint was 9.5 patients per 1000 inhabitants with 1 out of 10 patients requiring hospitalization. The average payment received per faint patient evaluation was $2,517 resulting in an estimated yearly cost equal to $90,901,958.

Similarly, Falls in older people are common and their impact can be devastating, causing significant morbidity and mortality. Up to thirty-five percent of adults greater than 65 years old sustain at least one fall and the incidence increases to 32-42% in adults older than 75 years of age. The average payment received per fall patient evaluation was $3,200, respectively resulting in an estimated yearly cost equal to $351,959,040.

Despite the recently published guidelines, the evaluation and treatment of patients with Faint or Fall is often haphazard and un-stratified. The result is inappropriate use of diagnostic tests and a high rate of misdiagnosis. In non- standardized clinical practice settings, the rate of unexplained faint is 42%-54% highlighting the importance of adopting standardized diagnostic protocols and algorithms in the medical practitioner's approach to patients with faint. Similarly, several studies have identified multiple risk factors for Fall patients highlighting the multifaceted nature of this problem.

THE CHALLENGE TO HEALTHCARE PAYERS

F2 Solutions provides the tools needed to decide whether the short-term risk is high and an admission is warranted when patients present to the ED with a Faint. In the outpatient setting, F2 Solutions provides the Payers with an informational reference for them to assess whether the tests ordered in the management of patients with Faint were cost-effective and in adherence with the most recent published guidelines.

In a recent study involving 254 patients who presented to the Emergency Department with Faint, the number of inappropriate admissions and discharges were 69 out of 118 (58%) and 8 out of 136 (6%) respectively. The prevalence of Serious Events (SE) in the inappropriately admitted group (n=69) was not significantly different than in the appropriately discharged group (n=128)(3% versus 3%, p=NS). Similarly, the prevalence of SE in the inappropriately discharged group (n=8) was not significantly different than in the appropriately admitted group (n=49)(13% versus 16%, p=NS). In another study including patients presenting with Faint, there was underutilization of orthostatic testing (p=0.001), carotid sinus massage (p=0.001), and implantable loop recorders (p=0.07) and overutilization of imaging studies (p=0.001 for both echocardiogram and CT/MRI scan) and neurologic consultation (p=0.001).

By providing readily available information in algorithmic format, F2 Solutions helps healthcare payers and providers identify appropriate patients for admission, thus meeting the challenge of providing superior patient care at lower cost.

* Annals of Emergency Medicine
** Europace
*** PACE 2010