Syncope / pre-syncope

Red flags

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

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 concerning features (see emergency section)

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.

Essential referral information

Details of all treatments offered and efficacy
Relevant medical history
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
Family history of cardiac disease or sudden cardiac death
Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
FBC, TSH, ELFTs
All available ECGs

Additional Referral Information (Useful for processing the referral)

Holter monitor report (only useful if daily symptoms)
Echocardiogram report
CXR report
Serum magnesium results
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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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

Clinical Information (essential)

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

Patient’s Demographic Details (essential)

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

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Other Information (where relevant)

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

Fax: 1300 364 952

Electronic: eReferral system

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

Locations

Resources

Specialists list