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.

  • fall related trauma resulting in any of the following:
    • displaced fractures
    • major soft tissue injury (including skin tears)
    • suspected head injury or intracranial hypertension
    • decreased Glasgow Coma Scale (GCS) after unwitnessed fall

Please contact the on-call registrar to discuss your concerns prior to referring.

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • Aboriginal and/or Torres Strait Islander people aged greater than 50 years with either:
    • two or more falls within the past 4 weeks, or
    • one fall resulting in serious injury
  • people aged greater than 65 years with either:
    • two or more falls within the past 4 weeks, or
    • one fall resulting in serious injury

Category 2 (appointment clinically indicated within 90 days)

  • Aboriginal and/or Torres Strait Islander people aged greater than 50 years with either:
    • two or more falls within the last 12 months, and/or
    • falls resulting in overall physical, social, or psychological functional decline
  • people aged greater than 65 years  (50 years for people identifying as Aboriginal and/or Torres Strait Islander) with
    • two or more falls within the last 12 months, and/or
    • falls resulting in overall physical, social, or psychological functional decline

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.

  • care-giver or third-party contact details if patient consenting
  • advanced care directives status
  • age
  • past medical/surgical/psychosocial history
  • use/frequency of alcohol, tobacco, and other drugs
  • current medications and dosages, including:
    • over the counter medications and complementary medicines, and indications
    • flag specific drugs of concern
    • home medicines review or residential medication management review
    • medication adherence
    • adverse reactions or medication-related hospitalisations
    • use of any medication administration aids
    • history of attempts to wean or cease specific medications
  • allergies and sensitivities
  • presenting symptoms including:
    • number of falls in the previous 12 months
    • onset, triggers and progression of falls
    • hospital presentations/admissions resulting from falls, including injuries
    • functional impact on quality of life
    • contributing factors for example, urge/stress incontinence, hemiplegia, neuropathy
    • treatments trialled/implemented prior to referral
  • management history including:
    • allied health assessment reports
    • family/informal supports and frequency of visits
    • NDIS/My Aged Care service providers and frequency of visits
  • cognitive assessment
  • height/weight
  • body mass index (BMI)
  • postural blood pressure
  • echocardiogram (ECG)
  • bone mineral densitometry
  • physical examination findings
  • pathology:
    • complete blood examination (CBE)
    • urea, electrolyte, and creatinine (UEC)
    • liver function test (LFT)
    • vitamin D level
    • mid-stream urine sample (MSU) 
  • relevant diagnostic/imaging reports, including location of company and accession number

Clinical management advice

The most significant risk factor for falls, as well as a predictor for future falls, is a history of falls within the previous year. Older individuals who have experienced a fall or deemed to be prone to falling should undergo observation for deficiencies in balance and gait. They should also be evaluated for potential interventions aimed at enhancing strength and balance. Several strategies for preventing falls and reducing the risk of fractures include:

  • continence nurse for prevention and management
  • dietitian for nutritional support
  • occupational therapy for home safety assessment
  • optometrist for visual acuity, cataracts, glasses
  • pharmacy for medication review
  • physiotherapy for assess mobility and gait
  • podiatry for mechanical and footwear assessment
  • vitamin D and calcium supplementation

People residing in high-level aged care facilities may be directed to Local Health Network (LHN) community in-reach teams for assessment at their residence where appropriate.

If polypharmacy, or drug interaction is suspected, consider referring for a home medicines review/residential medication management review.

Elderly patients may experience diminished appetite, dental issues, swallowing difficulties, and chronic medical conditions, all of which can contribute to malnutrition. Allied health professionals, including dietitians, speech pathologists, occupational therapists, and physiotherapists, are essential in assessing and managing these complexities. They collaborate to develop tailored nutrition plans, improve oral health, facilitate safe swallowing, improve safety barriers within the home, and enhance mobility, ultimately promoting better nutritional outcomes and overall quality of life. Allied health involvement should be considered in conjunction to referrals for specialist medical assessment.

Outpatient services are not meant to substitute for care and assistance available through other health programs that elderly patients might qualify for, such as services provided by My Aged Care or the National Disability Insurance Scheme (NDIS).

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.