The Manchester/RABTC Model

The Manchester/Rapid Access Blackouts triage Clinic (RABTC) Model

You can download the Minimum Care Pathway diagram, which represents the steps that should be followed to lead to the timely diagnosis of a patient presenting with blackouts/T-LoCs.

The Manchester Model, also known as the Rapid Access Blackouts triage Clinic (RABTC), was set up by Consultant Cardiologist and Cardiac Electro-physiologist Adam Fitzpatrick, based at the Manchester Heart Clinic, Manchester Royal Infirmary.

Each patient referred by a GP or A&E department must complete an online questionnaire upon arrival at the RABTC, which will form part of the group case review. Data collected from patients are stored in a central, secure database and can be accessed by staff at the RABTC at which they were collated and by the specialist to whom the patient is referred - this provides continuity of care. The data can also be accesssed anonymously by staff at other affiliated centres.

Who staffs and manages an RABTC?

Nurses

An RABTC is staffed and managed by nurse specialists, in the fields of:

• Epilepsy
• Arrhythmia
• Care of the Elderly
• Paediatrics

Specialist Consultant

A cardiologist and a neurologist are also on hand in the clinic, to perform and interpret tests as appropriate.

Timing

Staff dedicate four hours of their time on one day per week to the RABTC clinic. The time is divided in the following way:

Hours one to three:

• The specialist nurses work in parallel to assess each patient, using data from his/her online questionnaire
• Cardiology and/or neurology investigations are performed and interpreted by the on-hand cardiologist and/or neurologist

Hour four:

All clinic staff meet to discuss the cases seen that day, and decide upon a preliminary diagnosis for each patient. Based on this they refer patients to one of the following:

• A cardiologist
• A neurologist
• A geriatrician
• A psychologist
• A general practitioner
• A paediatrician

With the exception of the general practitioner, all the medical specialists above will be RATC partner consultants, and will have access to the RABTC central database of information.

The consultants use their patient’s original online questionnaire to confirm the diagnosis of the patient’s T-LoC and decide upon the most appropriate course of treatment and follow-up.