Improving referrals for tilt table testing in patients with transient loss of consciousness

Tilt table testing has been used for over twenty years in the investigation of patients with transient loss of consciousness. The European Society of Cardiology (ESC) recently recommended new guidance regarding indications for tilt table testing. We conducted an educational intervention and produced a new referral proforma that referring clinicians are expected to fill in for all patients referred for tilt table testing. At baseline, 76% (n=84) of referrals for tilt table testing were made in accordance to ESC guidance. Following a simple educational intervention, 100% (n=6) were in line with ESC guidance. After the introduction of the referral proforma, 92% (n=12) of referrals followed ESC guidance. At final data collection, 100% (n=11) of referrals followed ESC guidance. In conclusion, a simple educational intervention and the use of a referral proforma in this quality improvement project have made a sustained difference in improving the appropriateness of referrals for tilt table testing. This has the potential to optimise the efficient use of resources and improve patient care through avoiding unnecessary investigation.