Last reviewed
2026-02-07
Workflow pack
Syncope/presyncope triage workflow
Risk-tiered syncope workflow emphasizing urgent cardiac/neurologic exclusion and safe outpatient follow-up.
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 evaluation of syncope and presyncope where immediate resuscitation is not required at triage.
Exclusions (escalate/redirect)
- Persistent unstable vitals or active emergency management situations.
- Complex inpatient syncope protocols requiring monitored admission workflows.
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
- Confirm event characteristics to distinguish syncope from mimics.
- Assess for cardiac, neurologic, and hemodynamic high-risk features.
- Establish whether disposition can remain outpatient safely.
Red flags / escalate now
- Exertional syncope, syncope with chest pain/palpitations, or abnormal perfusion.
- New focal neurologic deficits or persistent altered mentation.
- Recurrent unexplained episodes with injury or high-risk context.
First-line plan
- Use structured risk framing and targeted baseline workup.
- Provide safety counseling including activity/drive restrictions when indicated.
- Document escalation criteria clearly if outpatient pathway is chosen.
Follow-up and monitoring
- Arrange early reassessment for unresolved etiology.
- Escalate rapidly for recurrence, injury, or evolving instability.
- Coordinate specialist referral for high-risk or uncertain cases.
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.