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Syncope / pre-syncope

Red flags

Consider immediate referral of patients with any of the following:

  • Exertional onset
  • Chest pain
  • Persistent hypotension (Systolic BP <90mmHg) associated with symptoms
  • Severe persistent headache
  • Focal neurologic deficits
  • Preceded by palpitations
  • Associated injury

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

  • Syncope with unclear aetiology (if cardiac aetiology is thought likely see Cardiology CPC)
  • Vasovagal syncope occurring on a weekly basis
  • Syncopal episodes that have resulted in physical injury (but not so severe as to warrant ED presentation)
  • Symptomatic orthostatic hypotension (of more than 20mmHg decrease in systolic blood pressure)

Category 2

Appointment within 90 days is desirable

  • Vasovagal syncope occurring on less than weekly basis but at least once a month
  • Asymptomatic orthostatic hypotension

Category 3

Appointment within 365 days is desirable

  • Vasovagal syncope occurring infrequently (less than once a month)

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

  • If syncope thought likely to be of cardiac origin see Cardiology CPC (coming soon).
  • If possible please identify an eye witness to any episode of syncope and request that the witness attends the specialist outpatient appointment with the patient.
  • Refer to HealthPathways for assessment and management information if available

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Relevant medical history, co-morbidities and medications
  • Details of clinical presentations:
    • include timeline since onset of symptoms
    • precipitating factors
    • any warning pre-syncopal symptoms
    • loss of consciousness (complete vs partial; duration; nature of recovery)
    • witnessed signs (including seizures, pallor, incontinence, cyanosis, irregular or absent pulse during attack, associated injury)
  • Lying and standing BP
  • Drug and alcohol history
  • FBC, ELFT & TSH results
  • ECG

Additional Referral Information (Useful for processing the referral)

  • Any investigations relevant to co-morbidities (eg HbA1c if diabetic, spirometry  if COPD)
  • EEG results (if available)
  • Holter monitor or event monitor results (if available)
  • Echocardiogram results (if available)

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.)
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