Housebound patient reports recurrent collapses. Declines to be conveyed to hospi

Management approach for a housebound patient with recurrent collapses who declines hospital conveyance and refuses home visit for capacity assessment:

• Respect the patient's autonomy and decisions, as people have the right to make informed decisions about their care, including refusing hospital conveyance and home visits for capacity assessment. The healthcare team should continue attempts to engage the patient in discussions about the risks associated with their recurrent collapses and the potential benefits of assessment and treatment.
• Ensure patient safety by assessing the risk associated with their collapses indirectly through history taking from the patient and any witnesses, and reviewing any available clinical information remotely. Record detailed information on circumstances, prodromal symptoms, and injuries, if possible.
• Offer education about possible causes of the collapses, safety precautions, and lifestyle modifications to reduce recurrence and injury risk, such as avoiding known triggers, maintaining adequate hydration, and physical counter-pressure maneuvers if prodromal symptoms occur.
• Advise on avoiding high-risk activities such as driving or operating machinery until a diagnosis is established and the patient is considered safe by a specialist. Provide information on statutory obligations such as notifying the DVLA, if relevant.
• Provide information about sources of support like the Syncope Trust And Reflex Anoxic Seizures (STARS) and PoTS UK charities for patient education and self-management.
• If home assessment for capacity is refused and urgent evaluation is necessary due to suspected life-threatening causes or serious injury, consider involving safeguarding teams, mental health crisis teams, or social services to undertake risk assessment and appropriate actions. Escalate care planning to multidisciplinary teams, ensuring documentation of all discussions and refusals.
• Maintain a flexible and proactive approach by continuing to offer assistance and assessment opportunities, ensuring the patient understands the rationale and potential benefits, and documenting capacity considerations appropriately.

This approach balances respecting patient autonomy with clinical responsibility to manage recurrent syncope and minimize harm.

NICE CKS,NICE CG109