Quality statement 2: Initial assessment – 12-lead electrocardiogram (ECG)
People who have had a transient loss of consciousness have a 12-lead electrocardiogram (ECG) during the initial assessment.
A 12-lead ECG is an important initial diagnostic test for identifying the likely cause of the transient loss of consciousness in some people, and especially in predicting adverse events (for example, ECG abnormalities that are 'red flag' signs or symptoms may suggest structural heart disease or potential for arrhythmic syncope). A 12-lead ECG should be used by appropriately trained healthcare professionals (such as paramedics and GPs) to identify people who may be at high risk of a serious event, and who should therefore be referred for urgent specialist cardiovascular assessment.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Evidence of local arrangements to ensure that people who have had a transient loss of consciousness have a 12-lead ECG during initial assessment.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.
Proportion of people who have had a transient loss of consciousness who have a 12-lead ECG during initial assessment.
Numerator – the number in the denominator who have a 12-lead ECG during initial assessment.
Denominator – the number of people who have had a transient loss of consciousness.
Service providers (first-line staff such as paramedic and emergency service staff, GPs, and out-of-hours staff) ensure that people who have had a suspected transient loss of consciousness have a 12-lead ECG recorded during the initial assessment. Service providers ensure that systems are in place to offer training to healthcare professionals according to local need in relation to competent interpretation of 12-lead ECG recordings.
Healthcare professionals (such as paramedics and GPs) ensure that people who have had a suspected transient loss of consciousness have a 12-lead ECG recorded during the initial assessment and that the results are interpreted competently.
Commissioners (NHS England area teams, integrated care systems and clinical commissioning groups) ensure that all service providers have appropriate capacity in place to provide access to 12-lead ECGs.
People who have a blackout have an ECG (short for electrocardiogram) test during their initial assessment. This records electrical signals from the heart and may help to identify problems that can cause blackouts.
Transient loss of consciousness in over 16s. NICE guideline CG109 (2010, updated 2014), recommendations 22.214.171.124, 126.96.36.199 (key priorities for implementation), and 188.8.131.52
A test that records the heart's electrical signals, obtained by attaching electrodes in 10 standard positions on the limbs and the surface of the chest. The 12-lead ECG recording should be reported automatically, or if automated analysis is not available, by a healthcare professional competent in ECG interpretation and trained to identify specific potentially life-threatening abnormalities. This must be interpreted in the full context of the detailed history and clinical signs.
When care is transferred, copies of the ECG recording and the patient report form should be given to the receiving clinician and to the person who has had the transient loss of consciousness. [Adapted from NICE's guideline on transient loss of consciousness in over 16s, full guideline glossary and abbreviations and expert opinion]