Initial experience with a rapid access blackouts triage clinic

Abstract

-Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The UK has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate.

Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

“…Other medical subspecialties have carried similar principles of risk-based triage to ensure high-risk patients are seen in a timely manner. 6,17,29,30 Our novel approach provides a standardized pathway to triaging low-risk patients and objectively allows higher risk referrals to be identified. When referrals are not felt to be indicated, we provide individualized correspondences back to referring providers on suggested management and continued surveillance of patients, as well as when a referral to nephrology should be reinitiated.…”

The Role of the Syncope Management Unit

“…Another model of care is an outpatient secondary referral center, 38 which consists of a multidisciplinary grouping including cardiologists and specialist nurses with experience in arrhythmias, falls, and epilepsy. Evidence-based Web algorithms are incorporated in care pathways for the management of patients, with emphasis on differential diagnosis between syncope, epilepsy, and psychogenic episodes.…”

Syncope Unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society

“…46 The Rapid Access Blackouts Clinic This type of SU functions as a 'referral centre' for patients with T-LOC. 47,48 As such, it is positioned between first response and specialist referrals. It is led jointly by a cardiologist and a neurologist.…”