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.

  • suspected sepsis or unexplained fever
  • severe disease with inability to function in the community – phone the rheumatology registrar or on call consultant to discuss options for admission

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

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

  • asymptomatic hyperuricaemia
  • previously diagnosed gout that is adequately managed
    • at target urate with no flares in the last 6 months

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • gout with frequent or difficult to treat flares, unable to use standard therapy

Category 2 (appointment clinically indicated within 90 days)

  • confirmed gout, diagnosed by joint aspirate or dual energy computed tomography.
  • suspected gout, for example, recurrent podagra, suggestive imaging including location of company and accession number
  • tophaceous gout with progressive joint damage, active symptoms or growing tophi despite medical management.
  • other crystal arthritis, for example calcium pyrophosphate deposition disease (pseudogout)

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.

  • complete medical history
  • details of previous medical management including the course of treatment and outcomes
  • current and previous medication history including non-prescription medicines, herbs and supplements
  • alcohol and smoking history
  • body mass index
  • employment status

History of presenting condition

  • description of joints affected and characteristics
    • number of joints involved and location
  • duration of symptoms
    • frequency of episodes and number of attacks in the last 12 months
  • symptoms
    • swelling
    • pain
    • morning stiffness greater or less than 30 minutes
  • clinical examination
  • 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)
    • inter-episode blood uric acid levels

Additional information to assist triage categorisation

  • family history of gout
  • results from previous joint aspirations
  • relevant diagnostic/imaging reports including location of company and accession number
  • 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.
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician

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.