Protocols for bradycardic events in non-hospital facilities
The Non-Hospital Medical and Surgical Facilities Patient Safety Incident Review Panel regularly reviews incidents of bradycardic events and vasovagal episodes where the treatment has varied, and patients are often transferred to hospital. These incidents are being shared to assist facilities in their continuous quality improvement.
The following recommendations are important to keep in mind when dealing with bradycardic events and vasovagal episodes.
- Standard protocols/algorithms should be developed to manage pre-intra-post procedure bradycardic events, including assessment of the need to send to the patient to hospital post-event.
- Patients identified with low resting heart rate should be considered for prophylactic anticholinergic therapy pre-procedure.
- Triaging needs to be done for patients before transferring to hospital. Healthy patients with no underlying co-morbidities and a clearly vasovagal event should be managed at the non-hospital facility as appropriate. The facility should be prepared to manage this type of expected complication.
- Workup for cardiac causes is not required for all patients. Recurrent/prolonged events, elderly patients and underlying cardiac concerns are reasons for transferring patients to hospital.
Medical directors and clinical leads are encouraged to share this information with the clinical team and review protocols for bradycardic events.