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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

Dupuytren’s nodules without presence of functional impairment or contracture

Triage categories

Category 1 — appointment clinically indicated within 30 days

  • severe contracture resulting in skin ulceration with or without infection

Category 2 — appointment clinically indicated within 90 days

  • fixed flexion deformity +/- 60° metacarpal phalangeal joint (MCPJ) +/- 40° proximal interphalangeal joint (PIPJ)
  • multiple joints or recurrent contracture with functional impairment post-surgery
  • rapidly progressing contracture

Category 3 — appointment clinically indicated within 365 days

  • flexion contractures +/- 30° MCPJ +/- 25° PIPJ
  • functional impairment

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.

  • complete past medical history including relevant surgical history
  • current medication list
  • management history including:
    • injury/trauma if relevant
    • onset and duration
    • severity
    • pain
    • associated features, e.g. functional impairment
    • use of immobiliser/splint/cast
    • treatments trialled/implemented prior to referral
  • functional range of motion (ROM)
  • tabletop testing (ability to flatten hands palms first onto tabletop)
  • plain X-ray, include radiological details/accession number

Please note that hand and wrist referrals can be managed by the following specialist services:

Consideration of risks versus benefits of surgical intervention may include:

  • age
  • frailty
  • additional comorbidities
  • patient expectations of outcome
  • patient suitable for surgery, engagement in self-management
  • body mass index (BMI) and weight loss
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation.

Optimisation of chronic medical conditions should occur as part of initial assessment and conservative management as this may impact on suitability for surgical intervention.

Proximal interphalangeal joint (PIPJ) contractures are more serious than metacarpal phalangeal joint (MCPJ) contractures.

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.