Last reviewed
2026-02-07
Workflow pack
Palpitations triage workflow
Workflow for rapid palpitations risk framing with escalation cues for unstable or high-risk rhythm presentations.
Trust and governance
Use only within this workflow's defined scope and exclusions.
Clinical owner
Family Medicine Editorial Team
Risk tier
High
Review cadence
Every 3 months
Next due 2026-05-07
Review status
Current
Scope limits
Initial outpatient palpitations assessment in clinically stable patients.
Exclusions (escalate/redirect)
- Hemodynamic instability or ongoing sustained unstable arrhythmia.
- Inpatient telemetry-based management scenarios.
References
Escalate-now emphasis (high-risk workflow)
If any red-flag item is present, stop routine workflow steps and activate emergency escalation immediately.
At a glance
Rapid decision framing for in-visit use. Educational only; always apply clinical judgment.
Immediate actions
- Check for associated syncope, chest pain, dyspnea, or poor perfusion symptoms.
- Document rhythm symptom pattern and potential triggers.
- Determine immediate escalation need before outpatient diagnostics.
Red flags / escalate now
- Palpitations with syncope, chest pain, hypotension, or severe dyspnea.
- Persistent rapid rhythm symptoms with instability signs.
- Rapid symptom progression in high-risk cardiac context.
First-line plan
- Stabilize reversible contributors and begin focused rhythm-risk workup.
- Use structured documentation for event pattern and associated red flags.
- Set early follow-up with clear escalation instructions.
Follow-up and monitoring
- Reassess quickly if episodes recur or intensify.
- Escalate urgently for new syncope, chest pain, or instability.
- Coordinate specialist review for unresolved high-risk patterns.
Condition guidance
Referral checklists
Tools and calculators
Return precautions (patient script)
Suggested plain-language wording for safety-net counseling:
If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.
- Use with the specific red flags listed on this page.
- Confirm follow-up timing and where to go after-hours.
- Document that return precautions were reviewed and understood.
Visit-close checklist
- Document disposition, rationale, and unresolved diagnostic uncertainty.
- Give explicit return precautions and follow-up timeline before ending visit.
- Attach a relevant handout when available to reinforce adherence and safety-netting.