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.

  • complications of disease or therapy requiring emergent review — systemically unwell

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

Category 1 (appointment clinically indicated within 30 days)

  • new onset polymyalgia rheumatica (PMR) with typical shoulder/hip girdle features with raised erythrocyte sedimentation rate / C- reactive protein
  • known and treated PMR established on steroids requiring further escalation of management or currently on a disease-modifying antirheumatic drugs (DMARDs)

Category 2 (appointment clinically indicated within 90 days)

  • polymyalgia rheumatica on active treatment on established DMARDs

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 treatments offered (non-steroidal anti-inflammatory drugs, prednisolone, glucocorticoids, disease-modifying antirheumatic drugs including dose and response
  • history of presenting condition:
    • description of affected areas, for example shoulders, hips, knees including which side
    • duration of symptoms
    • recurrence
    • symptoms, for example, muscle pain, morning stiffness greater or less than 30 minutes
  • clinical examination including presence of any joint swelling. If small joints, please specify metacarpophalangeal / proximal inter-phalangeal / distal interphalangeal joint / metatarsophalangeal joint
  • 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)

Additional information to assist triage categorisation

  • family history of polymyalgia rheumatica
  • 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
  • relevant/diagnostic/imaging reports including location of company and accession number
  • thyroid function tests
  • creatinine kinase
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide (anti-CCP)
  • serum protein electrophoresis (SPEP)
  • other screening previously performed including X-ray, hepatitis B, hepatitis C, human immunodeficiency viruses, QuantiFERON Gold (QFG), bone density
  • cancer screening information
  • 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.