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.

  • deterioration of renal function associated with obstruction
  • severe/uncontrolled haematuria
  • urinary retention with worsening symptoms
  • urinary tract sepsis/systemic infection

Please contact the urology registrar on call 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

Exclusions

  • concerns of renal failure/declining estimated glomerular filtration rate (eGFR) or proteinuria - refer to nephrology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • macroscopic haematuria
  • positive urine cytology
  • urinary tract imaging (ultrasound or computed tomography) suggestive of malignancy

Category 2 (appointment clinically indicated within 90 days)

  • microscopic haematuria

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.

  • relevant past medical/surgical/radiotherapy history
  • current medications and allergies e.g. use of nonsteroidal anti-inflammatory drugs, rifampicin, metronidazole, nitrofurantoin or cyclophosphamide
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
  • physical examination findings
    • abdominal e.g. palpable bladder
    • digital rectal examination (DRE) (men)/pelvic examination (women)
  • pathology
  • complete blood examination (CBE)
  • electrolytes, urea and creatinine (EUC)
  • repeat prostate-specific antigen (PSA) and free/total prostate-specific antigen (PSA) completed within 12 weeks of referral, refer to Prostate Cancer Foundation of Australia Clinical Guidelines on PSA Testing
  • mid-stream urine (MSU) M/C/S
  • computed tomography (CT) urogram (pre and post intravenous contrast + delayed pyelograms) unless contraindicated
  • kidneys, ureters and bladder (KUB) ultrasound (US) if CT contraindicated
  • relevant diagnostic/imaging reports including location of company and accession number

Additional information to assist triage categorisation

Pathology

  • urine cytology, may help to prioritise referral
  • sexually active people complete a sexually transmitted infection (STI) screen, including chlamydia and gonorrhoea which requires:
    • endocervical/penile swab for culture and
    • endocervical/penile polymerase chain reaction (PCR) swab or urine sample

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.