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.

  • acute/severe urinary tract calculi/colic with or without:
    • urinary outlet obstruction
    • systemic signs of infection
    • decreased renal function
    • uncontrolled pain
    • haematuria
    • patients with single kidney and/or renal transplant
    • acute urinary retention

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

  • urinary tract calculi/stone less than 5mm
  • nephrocalcinosis

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • proven calculi in ureter and any of the following:
    • decreased renal function and/or increasing pain
    • patients with single kidney and/or renal transplant

Category 2 (appointment clinically indicated within 90 days)

  • bladder calculi/stone
  • renal calculi greater than 1cm
  • staghorn calculi

Category 3 (appointment clinically indicated within 365 days)

  • asymptomatic calculi/stone greater than 5mm

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 history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
  • non-contrast intravenous pyelogram (IVP) computed tomography (CT), unless contraindicated
  • relevant diagnostic/imaging reports including location of company and accession number

Pathology

  • complete blood examination (CBE)
  • electrolytes, urea and creatinine (EUC)
  • liver function test (LFT)
  • estimated glomerular filtration rate (eGFR)
  • coagulation studies (Coags)
  • calcium (Ca)
  • phosphate (Po4)
  • urate
  • mid-stream urine (MSU) M/C/S
  • 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

Additional information to assist triage categorisation

  • pathology:
    • urine cytology may help to prioritise referral

Clinical management advice

To ensure the passage of ureteric calculi, it is recommended to conduct a follow-up imaging after initial ultrasound (US) or confirmation imaging 4 to 6 weeks later. If the stone persists consider referral for assessment in specialist outpatient services.

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.