Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute physiological disturbance unable to be managed solely by a General Practitioner, or existing community services for example, hospital avoidance and discharge support services
  • acute functional decline which is not able to be supported in the community through existing support pathways for example Royal District Nursing Service /My Aged Care providers/informal family supports

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Inclusions

General Medicine outpatient caters to a large variety of potential referral reasons. Our unit aims to provide advice for conditions which are thought beyond the scope of general practice and potentially not meeting specialty criteria for a given presentation. We welcome the following types of presentations:

  • multiple complex comorbidities requiring rationalisation of therapy and specialty referrals
  • assessment of complex medical presentations, often involving multiple systems
  • transition of care for paediatric patients with complex comorbidities into the adult sector
  • referrals which do not fit into a pre-specified specialty referral pathway
  • referrals to facilitate hospital avoidance from acute admission or rebound admission

Exclusions

  • conditions for which multidisciplinary team input and care coordination is requested for example, postural orthostatic tachycardia syndrome (POTS), Ehlers Danlos syndromes
  • conditions for which specialist criteria are met for example, Cognitive Impairment and Dementia Adult CPC or mental health services
  • non-specific referral without clearly defined objective/purpose for example, general review
  • obstetric/maternal foetal medicine
  • pre-operative ‘high-risk’ surgery assessment – refer utilising pre-existing referral pathways
  • symptoms/illness meeting threshold for emergency department presentation

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • acute exacerbation of chronic medical condition which:
    • impacts on other co-morbidities, and
    • requires close monitoring
  • rapidly progressive/recent onset of undifferentiated illness for which definitive diagnosis and/or management plan is required
  • recent discharge from hospital or emergency department (less than 4 weeks) and need for ongoing surveillance and optimisation of co-morbidities
  • unstable co-morbidities which require early medical intervention to prevent further deterioration with a high risk of hospitalisation

Category 2 (appointment clinically indicated within 90 days)

  • chronic symptoms/condition with any of the following:
    • requiring optimisation and/or management to minimise long term impairment
    • causing significant social/economic/functional impairment
  • stable co-morbidities that require risk assessment and medical optimisation to prevent further deterioration with a low/moderate risk of hospitalisation
  • stable/slowly progressive undifferentiated illness for which definitive diagnosis and/or management plan is required

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • specific reason for referral
  • full list of previous diagnoses medical/surgical/psychosocial
  • full list of current medications and dosages
    • over the counter medications and complementary medicines, and indications
    • flag specific drugs causing concern 
    • medication adherence
    • use of any medication administration aids
    • home medicines review or residential medication management review
    • adverse reactions or medication-related hospitalisations
    • use of any medication administration aids
    • history of attempts to wean or cease specific medications
    • list of all clinicians involved in prescribing medications and contact information
  • allergies and drug sensitivities
  • details of existing management plans
  • details of history and examination findings related to reason for referral
  • relevant pathology results related to reason for referral within last 12 weeks
  • relevant diagnostic/imaging reports including location of company and accession number
  • accurate contact details for patient and alternative contact

Additional information to assist triage categorisation

  • details of existing management plans including;
    • medical/allied health assessment reports
    • family/informal supports and frequency of visits
    • National Disability Insurance Scheme/My Aged Care service supports and frequency of visits
  • details of history and examination findings related to reason for referral
  • height/weight
  • body mass index (BMI)
  • blood pressure
  • depression screening score
  • cognitive assessment, Mini-Mental State Examination (MMSE)
  • pathology less than 12 weeks:
    • complete blood examination (CBE)
    • electrolyte, urea and creatinine (EUC)
    • liver function test (LFT)
    • mid-stream urine specimen (MSU) 

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.