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.

  • AF with red flags:
    • haemodynamic instability
    • shortness of breath
    • chest pain
    • syncope/pre syncope/dizziness
    • known Wolff-Parkinson-White syndrome
    • neurological deficit indicative of transient ischaemic attack/stroke

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 well controlled chronic AF

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • new AF without red flags
  • recurrent paroxysmal AF
  • AF with signs of heart failure (HF) or reduced left ventricle (LV) function not requiring presentation to emergency department

Category 2 — appointment clinically indicated within 90 days

  • chronic unstable/uncontrolled AF requiring management review e.g. rate control, anticoagulation, further intervention
  • recent onset AF without haemodynamic compromise

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
  • complete blood examination (CBE)
  • urea, electrolytes and creatinine (UEC)
  • liver function tests (LFTs)
  • blood sugar levels
  • estimated glomerular filtration rate (eGFR)
  • thyroid stimulating hormone (TSH)
  • electrocardiogram (ECG), specifically during episode/s of arrythmia, and any other concerning tracings

Additional information to assist triage categorisation

  • relevant reports and investigations e.g. echocardiogram (Echo), chest x-ray, holter monitor, and sleep study
  • use/frequency of alcohol, tobacco and other drugs

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.

To minimise the burden of atrial arrhythmia (new onset < 48hrs) with early cardioversion, contact cardiology on call in your Local Health Network to escalate and discuss clinical concerns.

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.