Syncope / pre-syncope (General Medicine)


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Syncope / pre-syncope

  • Syncope / pre-syncope with any of the following concerning features
    • exertional onset
    • chest pain
    • persistent symptomatic hypotension (systolic BP < 90mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by palpitations
    • associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
    • family history of sudden cardiac death


  • Any condition defined by other CPCs as requiring referral to emergency
Useful Management Information
  • If syncope thought likely to be of cardiac origin see Cardiology syncope / pre-syncope CPC
  • If possible please identify an eye witness to any episode of syncope and request that the witness attends the specialist outpatient appointment with the patient.
Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

  • Syncope with unclear aetiology (if cardiac aetiology is thought likely see Cardiology CPC)
  • Vasovagal syncope occurring on a weekly basis
  • Syncopal episodes that have resulted in physical injury (but not so severe as to warrant ED presentation)
  • Symptomatic orthostatic hypotension (of more than 20mmHg decrease in systolic blood pressure)
Category 2
(appointment within 90 calendar days)
  • Vasovagal syncope occurring on less than weekly basis but at least once a month
  • Asymptomatic orthostatic hypotension 
Category 3
(appointment within 365 calendar days)
  • Vasovagal syncope occurring infrequently (less than once a month)

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service
Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be rejected

  • General referral information
  • Relevant medical history, co-morbidities and medications
  • Details of clinical presentations:
    • include timeline since onset of symptoms
    • precipitating factors
    • any warning pre-syncopal symptoms
    • loss of consciousness (complete vs partial; duration; nature of recovery)
    • witnessed signs (including seizures, pallor, incontinence, cyanosis, irregular or absent pulse during attack, associated injury)
  • Lying and standing BP
  • Drug and alcohol history
  • FBC, ELFT & TSH results
  • ECG
Additional Referral Information
  • Any investigations relevant to co-morbidities (eg HbA1c if diabetic, spirometry  if COPD)
  • EEG results (if available)
  • Holter monitor or event monitor results (if available)
  • Echocardiogram results (if available)
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.


To provide feedback about contents on this website or general referral questions please email or phone 3413 7402.