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 acute coronary syndrome
  • suspected pulmonary embolism or aortic dissection
  • suspected or confirmed endocarditis, myocarditis or pericarditis
  • suspected ischaemic chest pain within 24 hours with any of the following red flags:
    • severe or ongoing chest pain
    • prolonged chest pain ≥ 10 minutes
    • chest pain at rest or with minimal exertion
    • chest pain associated with severe dyspnoea
    • chest pain associated with syncope/pre-syncope
    • respiratory rate ≥ 30 breaths per minute
    • tachycardia ≥ 120 beats per minute (BPM)
    • systolic blood pressure (BP) ≤ 90mmHg
    • heart failure (HF)/suspected pulmonary oedema
    • ST elevation or depression
    • complete heart block
    • new left bundle branch block
  • symptomatic atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT)
  • acute unstable angina/new onset angina
  • nocturnal angina

    • 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

    Regional services

    • Integrated Cardiovascular Clinical Network SA (iCCNet SA) (08) 7117 0600

    Exclusions

    • Stable asymptomatic ischaemic heart disease more than 12 months since an acute cardiac event. These patients require regular follow-up with GP and aggressive risk factor management.

    Triage categories

    Category 1 - appointment clinically indicated within 30 days

    • new chest pain of possible cardiac origin without any red flags
    • chest pain suggestive of angina
    • known coronary artery disease (CAD) with recurrent symptoms, without red flags

    If concerned that clinical condition requires more urgent review, contact cardiology registrar (see ‘Contacts for clinical advice’) to discuss case and facilitate earlier review if required.

    Category 2 - appointment clinically indicated within 90 days

    • chronic suspected cardiac chest pain without red flags and not previously investigated

    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.

    • description of symptoms, frequency, duration and risk factors
    • presence of red flag symptoms
    • alleviating interventions and management
    • complete medical history
    • details of previous treatments and outcomes
    • current medication and previous therapies including risk factor management
    • known allergies and sensitivities
    • blood results:
      • complete blood examination (CBE)
      • urea, electrolytes and creatinine (UEC)
      • liver function tests (LFTs)
      • blood sugar levels
      • estimated glomerular filtration rate (eGFR)
      • fasting lipids
      • glycated haemoglobin test (HbA1c)
    • electrocardiogram (ECG), specifically during episode/s of chest pain, and any other concerning tracings

    Additional information to assist triage categorisation

    • relevant investigations and reports e.g., chest x-ray, cardiac imaging: stress test, stress echocardiogram (Echo) or myocardial perfusion scan (MPS), coronary artery calcium score or CT Coronary Angiogram
    • Cardiovascular Risk Calculator
    • use/frequency of alcohol, tobacco and other drugs
    • weight

    Clinical management advice

    Patients who have been seen by a specialist cardiologist previously, are encouraged to be referred back to their care for further review.

    New symptom development on a background of previous angina/myocardial ischaemia/coronary artery disease (CAD) should be assessed promptly, and referred back to previous treating cardiologist.

    Patients with chronic stable angina or chest pain are advised to commence aggressive risk factor management with their General Practitioner (GP) (refer to ‘Clinical resources’).

    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.