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PoTS UK welcome you to our training event for Nurses Setting up and delivering a Syncope Service.Why a Syncope Clinic?Burden of Syncope • 1-3% ED visits • 32% admitted • 50% patients leave with no diagnosis • 50% admissions >75 yrs • 10% falls in elderly are attributed to syncope • related ED attendances, hospital admissionsope and injuries will continue to rise • Cardiac syncope has a significantly increased risk of death Challenges • 6 most common reason for attending ED • Limited time to diagnose and treat • Lack of access to appropriate investigations • Accompanying injuries • Appropriate assessment? • Significant drain on bed days • Red flags • Repeat attendances • No dedicated pathway resulting in fragmented/ delayed careBenefits • Reduction in repeat attendances • Fewer repeat syncope cases SYNCOPE UNITS • Reduced admissions REDUCE THE • Appropriately treat as an outpatient BURDEN OF referral instead of admitting SYNCOPE ON SECONDARY • Enables ED to achieve targets safely CARE, INCREASE LIKELIHOOD OF A • Security in patient care DIAGNOSIS AND SUBSEQUENT • Dedicated pathway for specific and TREATMENT focussed care • Clear risk stratification • High risk patients clearly definedInspiration The inspiration for this service came from the Blackout service at James Cook University Hospital. Their initial team consisted of: • 5 Consultant Cardiologists • 1 Consultant Neurophysiologist • 6 CRM Specialist nurses • 1 Epilepsy Nurse Consultant • 1 CRM Nurse Consultant • 8 Cardiac Physiologists (7 wte) • 2 Health Care Assistants • 3 Administrative AssistantsGuidelinesWhere to start? STAFF STUFF SPACE SYSTEMS WHERE YOU ARE WHERE YOU WANT TO BE This Photo by Unknown Author is licensed under CC BY-NC Staff • 1 Arrhythmia Specialist Nurse • Planned to complete MSc Module Investigation and Management of Arrhythmias and Blackouts • 1 PPC (shared with other services) • 1 supervising Cardiologist • 6 Cardiologists • 1 cardiac physiologist (and the team)Creating a system wide team…Allies STROKE CARE OF THE ELDERLY ED CARDIOLOGY DIVISIONAL NEUROLOGY MANAGERS MATRONS/HEAD OF SERVICEStuff Ability to refer for: • tilt table testing • external and internal (implantable) ECG loop recorder systems • 24 hour ambulatory blood pressure monitoring • 24 hour ambulatory ECG monitoring • Echocardiography • intracardiac electrophysiologic testing • stress testing • cardiac CT/ MRIThe pathway AIM TO VET REFERALLS WITHIN 48 HOURS OF RECEIVING THEM AND TO OFFER A CLINIC APPOINTMENT WITHIN 14 DAYSDRIVING Assessing a patient’s fitness to drive 5.When diagnosing a patient’s condition, or providing or arranging treatment, you should consider whether the condition or treatment may affect their ability to drive safely. You should: • refer to the DVLA’s guidance Assessing fitness to drive – a guide for medical professionals, which includes information about disorders and conditions that can impair a patient’s fitness to driveSpace My Clinic Room Clinic space is often at a premium with demand far outweighing capacity. It was important to secure a suitable room, at the same time on a regular basis. Lots of communications between the various departments that share our outpatient space was vital.Systems Development Audit Governance Logistical Admin Training Referral PathwayWhere we were… Review of admissions via ED over 3/12 period. • 118 Admissions coded syncope • Average LOS – 1 day • 15 readmissions. • 5 syncoperdiacPotential? patients could have been discharged from ED.A Review Data for March 2019 – Jan 2020 • 72 patients • 31% autonomic dysfunction • Postural hypotension • Orthostatic hypotension • PoTS • Only 1 of these patients represented to clinic.are services following interventions in • 7% patients identified and treated with PPM. Syncope clinic expedited this process compared to traditional referral routes Key Learning REFERRALS CLINICAL PRACTICE AUDIT/ EVALUATION • Appropriate risk • Assessment/ history is • Be specific with what is assessment of each key. being measured. referral is vital. • Listen to your • Collect data as it • Not all referrals are patient…William becomes available. created equally! Osler • Enlist some help with • A much needed service • Inviting patients data collection. will grow – quickly. to bring a • Demand now ‘witness’ or a exceeds capacity. witness account This process has been a It is important to of events is learning and development ensure ongoing invaluable. opportunity which has expansion is • Identify and meet revealed gaps in the possible. training needs. clinicians knowledge and • Don’t create more • Clinical governance skill set. This will be referral pathways than • MDT meetings addressed before/ during the service can cope • The importance of re-audit. with. reflective practiceKey successes • 7% patients identified and treated with PPM. Syncope clinic expedited this process compared to traditional referral routes. • Patients with autonomic dysfunction had good response to intervention- only one known re-presented to Cardiology. • Reduced presentations to health care services. • Obvious cost savings to NHS. • Potential reduction in mortality. • Patient satisfaction • Job satisfaction Feedback Patient: • I felt heard and hopeful for the first time in years. • I was upset I was stopped from driving for a while but was happy that I got my pacemaker. • I had been collapsing for years and was told I can live the life I want to now I have beented treated. Colleague • Syncope is always a challenge at the front door. The syncope clinic provides us a safe avenue to discharge patients knowing they will be assessed in a timely manner. Top Tips Be humble Be brave Be persistent Evaluate, adapt, evaluate, adapt… Dream big, Start small CC BY-SA-NCicensed under