Syncope / pre-syncope (General Medicine)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Syncope / pre-syncope with any of the following concerning features:
      • exertional onset
      • chest pain
      • persistent symptomatic hypotension (systolic BP < 90mmHg)
      • severe persistent headache
      • focal neurological deficits
      • preceded by palpitations
      • associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
      • family history of sudden cardiac death
    • Refer to local HealthPathways or local guidelines
    • If syncope thought likely to be of cardiac origin see Cardiology syncope / pre-syncope CPC
    • If possible, please identify an eyewitness to any episode of syncope and request that the witness attends the specialist outpatient appointment with the patient.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Syncope with unclear aetiology (if cardiac aetiology is thought likely see Cardiology - syncope/pre-syncope 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 calendar days)
  • Vasovagal syncope occurring on less than weekly basis but at least once a month
  • Asymptomatic orthostatic hypotension
Category 3
(appointment within 365 calendar days)
  • Vasovagal syncope occurring infrequently (less than once a month)

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Relevant medical history, comorbidities and medications (including over the counter (OTC) and complementary 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
  • ECG

3. Additional referral information Useful for processing the referral

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

4. Request

  • Patient's Demographic Details

    • 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

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

    Relevant clinical information about the condition

    • 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

    Reason for request

    • 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 modifiers

    • 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

    Other relevant information

    • 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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 January 2025

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