Quality standard

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

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

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.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

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: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

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, integrated care systems 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.

People who have had a blackout and have 1 or more 'red flag' signs or 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

Transient loss of consciousness in over 16s. NICE guideline CG109 (2010, updated 2014), recommendation 1.1.4.2 (key priority for implementation)

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's guideline on transient loss of consciousness in over 16s, 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. [NICE's guideline on transient loss of consciousness in over 16s, full guideline, section 6.9 and expert opinion]