Initial experience with a rapid access blackouts triage clinic

• Published in: Clinical medicine (London, England) Vol. 11; no. 1; pp. 11 - 16
• Main Authors: Petkar, S, Bell, W, Rice, N, Iddon, P, Cooper, P, McKee, D, Curtis, N, Hanley, M, Stuart, J, Mackway Jones, K, Fitzpatrick, AP
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01-02-2011; Royal College of Physicians
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities - organization & administration; Biological and medical sciences; blackout; Diagnostic Errors; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Epilepsy - complications; Epilepsy - diagnosis; Female; General aspects; Humans; Male; Medical sciences; Middle Aged; misdiagnosis; Nervous system (semeiology, syndromes); Neurology; Prognosis; Referral and Consultation; Risk Assessment; Syncope - complications; Syncope - diagnosis; transient loss of consciousness (T-LOC); Triage - methods; triage clinic; Unconsciousness - diagnosis; Unconsciousness - etiology; Young Adult; blackout; transient loss of consciousness (T-LOC); triage clinic; misdiagnosis; Nervous system diseases; Accessibility; Consciousness impairment; Transitory; Sorting; Clinic; Medicine; Emergency; Neurological disorder; Faint
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmedicine.11-1-11

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.