Syncope / pre-syncope
Emergency department referrals
Phone on call Cardiology Registrar via:
- Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
- The Prince Charles Hospital switch - (07) 3139 4000
- Redcliffe Hospital switch – (07) 3883 7777
- Caboolture Hospital switch – (07) 5433 8888
and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Consider immediate referral of patients with any of the following:
- exertional onset
- chest pain
- persistent hypotension (systolic BP <90mmHg)
- severe persistent headache
- focal neurological deficits
- preceded by or associated with palpitations
- known ischaemic heart disease or reduced LV systolic function
- associated with SVT or paroxysmal atrial fibrillation
- pre-excited QRS (delta waves) on ECG
- suspected malfunction of pacemaker or ICD
- absence of prodrome
- associated injury
- occurs while supine or sitting
- seizures
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- New episode(s) of uninvestigated syncope / near syncope without any of the following concerning features:
- Exertional onset
- Chest pain
- Persistent hypotension (systolic BP <90mmHg)
- Severe persistent headache
- Focal neurological deficits
- Preceded by or associated with palpitations
- Known ischaemic heart disease or reduced LV systolic function
- Associated with SVT or paroxysmal atrial fibrillation
- Evidence of pre-excited QRS (delta waves) on ECG
- Suspected malfunction of pacemaker or ICD
- Absence of prodrome
- Associated injury
- Occurs while supine or sitting
- Seizures
Category 2
Appointment within 90 days is desirable
- Recurrent syncope previously investigated with undetermined cause
Category 3
Appointment within 365 days is desirable
- No Category 3 criteria
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Other important information for referring practitioners
Not an exhaustive list
- The NICE (UK) Guidelines for transient loss of consciousness may provide guidance on assessment and management
- Syncope may impact on a patient’s medical fitness to drive. The Queensland Government’s Transport and Motoring website has advice about managing driving
- Syncope that is suspected to be of non-cardiac origin may be referred to a general physician rather than a cardiologist depending on local services.
- Refer to HealthPathways for assessment and management information if available
Referral requirements
A referral may be rejected without the following information.
- Description of syncopal/pre-syncopal events including the following:
- Timeline
- Precipitating factors
- Any warning pre-syncopal symptoms
- Complete LOC or partial
- Duration of LOC
- Nature of recovery
- Witnessed signs
- Seizures
- Pallor
- Incontinence
- Cyanosis
- Irregular or absent pulse during attack
- Associated injury
- Lying / standing or sitting / standing BP
- All available ECGs
- Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
- FBC, TSH, ELFTs, magnesium results
Additional Referral Information (Useful for processing the referral)
- Details of all treatments offered and efficacy
- Relevant medical history
- Family history of cardiac disease or sudden cardiac death
- Holter monitor report (only useful if daily symptoms)
- Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
- FBC, TSH, ELFTs, magnesium results
- Echocardiogram report (if available)
- CXR report
- History of drug use (including recreational drugs)
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org