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Abstract
028 Nurse-facilitated suspected arrhythmia clinic: re-referral following missed diagnosis is uncommon
  1. A Smallwood,
  2. J Cotton,
  3. A Lapper
  1. Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK

Abstract

Objective Cardiac arrhythmia affects more than 700 000 people in England and is one of the commonest reasons for out patient referral to a cardiologist. Despite this, determining if a patients` symptomatology is indicative of a significant arrhythmia can be time consuming and challenging. Palpitations, pre-syncope and syncope are common complaints that may be linked to serious conditions, however the majority of subjects referred with these symptoms do not have a demonstrable cardiac dysrhythmia. An increased emphasis on delivering quality care has lead to major policy initiatives, of which a central requirement is that all people diagnosed with, or suspected of, having cardiac arrhythmias are referred to an arrhythmia specialist. Outpatient clinics focussing on the diagnosis and treatment of people referred with suspected arrhythmias, facilitated by both physicians and nurses, are emerging. Previous studies evaluating these clinics suggest that up to 68% of subjects referred have no arrhythmic basis for their symptoms. The purpose of this study was to determine frequency of and reasons for, re-referral to a local hospital of a cohort of patients who had been previously discharged from a nurse led arrhythmia clinic after no significant arrhythmic basis for their symptoms could be found.

Method All new referrals to a nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008 who were discharged from clinic without a diagnosis of definite cardiac arrhythmia were subject to an electronic search of the Trust's Patient Management System. Patients identified as having been re-referred to the hospital had their medical notes examined to determine if the reason for referral was due to a suspected or proven arrhythmia.

Results Three hundred two patients were referred to the nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008. 58% (n=175) had no significant arrhythmia detected. Of these 5% (n=8) were re-referred back into hospital with a history suggestive of possible dysrhythmia, such as dizziness, palpitations and syncope. These patients were predominantly female (n=6) with an age range of 43–86 years (average 53 years).Time from discharge to re-referral ranged from 9 to 18 months (average 14 months). Four patients presented to an emergency admissions facility, three were referred by their General practitioner to non-cardiac specialities and one self referred to a cardiologist. Following clinical assessment 1% (n=2) were diagnosed with an arrhythmia.

Conclusions Most people from this cohort, assessed at the suspected arrhythmia clinic who were found not to have a specific cardiological diagnosis, did not appear to subsequently re-present to hospital within the follow up period once they were discharged. Thus, these findings suggest that the ethos of a “one-stop” nurse-facilitated suspected arrhythmia clinic is effective at diagnosing people with a significant arrhythmia and adds detail to this aspect of care.

  • suspected arrhythmia clinic
  • nurse-facilitated
  • palpitations

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