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.

  • in general, chronic pain syndromes including fibromyalgia are not best managed in an emergency setting. People should not be referred to emergency services for flares of their existing symptoms

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

For clinical advice, please telephone the relevant specialty service.

Fibromyalgia is managed in the primary care setting. Complex fibromyalgia for patients residing in Central Adelaide Local Health Network can be referred to The Queen Elizabeth Hospital Rheumatology Outpatient Service

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • patients with an existing referral to the chronic pain unit

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • clarification of diagnosis and/ or management strategies for fibromyalgia
  • not improving after previous treatment, and patient amenable to further discussion of non-pharmacological therapies

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.

  • if the patient is pregnant or planning a pregnancy
  • complete medical history
  • details of previous medical management including the course of treatment and outcome
  • history of presenting condition:
    • symptoms suggestive of fibromyalgia diagnosis for example, generalised widespread pain fatigue, waking unrefreshed, cognitive symptoms, headaches, pain or cramping lower abdomen, depression
    • duration of symptoms: ≥ 3 months
    • impact of the symptoms
    • any clinical features of alternative diagnoses including inflammatory or connective tissue diseases
  • clinical examination including widespread tenderness and absence of swollen joints
  • blood results including location of company and accession number if available:
    • full blood count (FBC)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
    • liver function tests (LFTs)
    • erythrocyte sedimentation rate (ESR)
    • C-reactive protein (CRP)
  • interference with activities of daily living and working ability, for example, has the patient had to stop or change work practices, are they requiring assistance with self-care.

Additional information to assist triage categorisation

  • family history of fibromyalgia or autoinflammatory conditions
  • employment status
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • thyroid stimulating hormone (TSH)
  • creatine kinase (CK)
  • relevant allied health/diagnostic/imaging reports including location of company and accession number
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician

Clinical management advice

In general fibromyalgia is managed in the primary care setting. Complex fibromyalgia for patients residing in Central Adelaide Local Health Network (CALHN) can be referred to The Queen Elizabeth Hospital (TQEH) Rheumatology Outpatient Service. CALHN Rheumatology Outpatient Service (TQEH) can be contacted on (08) 8222 7010 or (08) 8222 7030.

To preserve rheumatology outpatient capacity for high acuity presentations, an alternative service model has been adopted at the Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH). Patients with uncomplicated non-inflammatory musculoskeletal conditions and recent onset inflammatory arthritis requiring fast tracking may be triaged into a physiotherapist-led clinic at the RAH or TQEH for assessment and management, with rheumatology consultant review as required. Outcomes may include provision of non-pharmacological management options in primary care or further imaging/pathology and review with a rheumatologist for ongoing care where indicated.

Discourage the use of opioid analgesics as they are rarely effective and may worsen fibromyalgia symptoms.

Please refer to HealthPathways South Australia - Fibromyalgia (log in required) for more information on clinical management and advice prior to rheumatology referral.

Clinical resources

Consumer resources

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.