Quality statement 3: Urgent specialist cardiovascular assessment within 24 hours of the initial assessment

Quality statement

People who have had a transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

Rationale

If people have had a transient loss of consciousness and 1 or more 'red flag' signs or symptoms have been identified, an urgent specialist cardiovascular assessment is needed within 24 hours of the initial assessment so that they can be assessed promptly for further investigation and treatment.

Quality measures

Structure

Evidence of local arrangements to ensure that people who have had a transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

Data source: Local data collection.

Process

Proportion of people who have had transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified who have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

Numerator – the number in the denominator who have an urgent specialist cardiovascular assessment within 24 hours.

Denominator – the number of people who have had transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified at initial assessment.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

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 transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

Healthcare professionals ensure that people who have had a transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

Commissioners (NHS England area teams and clinical commissioning groups) ensure that all service providers have appropriate capacity in place for people who have had a transient loss of consciousness and 1 or more 'red flag' signs or symptoms identified to have an urgent specialist cardiovascular assessment within 24 hours of the initial assessment.

What the quality statement means for patients, service users and carers

People who have had a blackout and have 1 or more 'red flag' signs or symptoms have an urgent specialist assessment within 24 hours of the initial assessment. 'Red flag' signs or symptoms indicate a high risk of a serious event such as having another blackout or a heart problem.

Source guidance

Definitions of terms used in this quality statement

'Red flag' signs or symptoms

'Red flag' signs or symptoms indicate that the person may be at high risk of a serious adverse event and should have an urgent specialist assessment within 24 hours. The signs or symptoms include:

  • an electrocardiogram (ECG) abnormality

  • heart failure (history or physical signs)

  • transient loss of consciousness during exertion

  • family history of sudden cardiac death in people aged younger than 40 years and/or an inherited cardiac condition

  • new or unexplained breathlessness

  • a heart murmur.

[Adapted from NICE clinical guideline 109, recommendation 1.1.4.2, and expert opinion]

Urgent specialist cardiovascular assessment

People at high risk of a serious cardiovascular or cerebrovascular adverse event need urgent investigation within 24 hours of the initial assessment.

Cardiovascular assessment is carried out by a specialist team that includes healthcare professionals who are experts in cardiovascular diseases and disorders. In some hospitals, this may be carried out in a clinic specialising in assessing people with a transient loss of consciousness.

[Based on NICE full clinical guideline 109 and expert opinion]