RT Journal Article
SR Electronic
T1 Initial experience with a rapid access blackouts triage clinic
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 11
OP 16
DO 10.7861/clinmedicine.11-1-11
VO 11
IS 1
A1 S Petkar
A1 W Bell
A1 N Rice
A1 P Iddon
A1 P Cooper
A1 D McKee
A1 N Curtis
A1 M Hanley
A1 J Stuart
A1 K Mackway Jones
A1 AP Fitzpatrick
YR 2011
UL http://www.rcpjournals.org/content/11/1/11.abstract
AB 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.