Clinical Resources

A library of clinical protocols, referral guidelines, and educational resources for junior doctors and ED clinicians. Use these resources to support safe referral decisions and ongoing cardiology learning.

Referral Criteria

Refer patients who meet the following criteria for urgent outpatient cardiology review within 24–48 hours. All referrals require sign-off by an ED senior (FACEM or senior Emergency registrar) before discharge.

  • Intermediate-risk chest pain (HEART score 0–3), assessed and discharged in accordance with local ED / LHD policy

  • No unstable symptoms and no dynamic change in troponin or ECG consistent with ACS

  • ED discharge summary attached or to follow

  • Patient able to attend outpatient clinic (not immobile, no social issues requiring admission)

HEART Score Calculator

Use the HEART score to stratify chest pain risk. Score 0–3: Low risk, suitable for RAC referral. Score 4+: High risk, consider same-day cardiology review or escalation.

  • H — History: Highly suspicious (2), Moderately suspicious (1), Slightly suspicious (0)

  • E — ECG: LBBB/ST depression (2), Non-specific repolarisation (1), Normal (0)

  • A — Age: ≥65 years (2), 45–64 years (1), <45 years (0)

  • R — Risk factors: ≥3 risk factors or known atherosclerotic disease (2), 1–2 risk factors (1), No risk factors (0)

  • T — Troponin: >3x normal (2), 1–3x normal (1), ≤normal (0)

Do Not Refer — Escalate Instead

These patients require immediate emergency assessment. Do NOT refer to this clinic if your patient has any of the following:

  • Haemodynamic instability (hypotension, shock)

  • Ongoing chest pain at rest — possible ACS

  • ST elevation or new LBBB on ECG

  • Sustained VT or VF

  • Complete heart block or Mobitz II

  • Acute decompensated heart failure with hypoxia

  • Syncope with ongoing haemodynamic compromise

Educational Resources for Junior Doctors

The following resources are recommended for junior doctors working in emergency and acute medicine who refer to the Rapid Access Cardiology Clinic.

  • Chest Pain Assessment — NBH ED Pathway (see Referral Pad for criteria)

  • HEART Score — Chest Pain Risk Stratification Tool

  • ACS Management — Chest pain with troponin rise

  • Atrial Fibrillation — Rate vs rhythm control, anticoagulation criteria, CHA₂DS₂-VASc score

  • Syncope Assessment — Causes, Canadian Syncope Risk Score, when to admit vs discharge

  • ECG Interpretation — Key abnormalities: STEMI, LBBB, AF, heart block, long QT, WPW

  • Palpitations Pathway — Sustained vs paroxysmal, Holter monitoring indications

These resources will be expanded over time. If you have questions about a referral, call the RAC team directly. Ph (02) 8488 8900.