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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Inclusions

  • venous thromboembolism (VTE) in pregnancy will be reviewed in the haematology clinic. Please provide information on gestation as well as current anticoagulation treatment.
  • thrombosis due to malignancy or hormone-induced requiring the development of a primary care management plan
  • recurrent multiple episodes of unprovoked thrombosis

Exclusions

  • first episode of provoked thrombosis which are associated with recent (<4 to 6 weeks) surgery, immobility or trauma are usually not reviewed in the haematology clinic
  • most patients with superficial thrombophlebitis
  • advice regarding anticoagulation can be sought from the duty haematologist but does not require a clinic review

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • venous thromboembolism (VTE) in pregnancy will be reviewed in the haematology clinic.
    • please provide information on gestation as well as current anticoagulation treatment

Category 2 (appointment clinically indicated within 90 days)

  • thrombosis due to malignancy or hormone-induced requiring the development of a primary care management plan
  • recurrent multiple episodes of unprovoked thrombosis

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.

  • current medication list
  • past medical history
  • blood results
    • complete blood examination (CBE)
    • blood film examination
    • liver function tests (LFTs)
    • electrolytes, urea, creatinine (EUC)
    • estimated glomerular filtration rate (eGFR)
  • history of prior thrombosis or miscarriages
  • family history of thrombosis
  • relevant prior imaging for those previous thrombosis

Clinical management advice

Conditions that may increase the risk of venous thromboembolism (VTE) include malignancies, recent long distance travel, recent immobility for example, injury, trauma or surgery, pregnancies. The usual treatment duration for a provoked VTE varies between 6 weeks to 3 months, and in the outpatient setting, may include enoxaparin, warfarin and direct oral anticoagulant (DOACs) such as apixaban and rivaroxaban.

Low- risk superficial vein thrombosis

Isolated superficial vein thrombosis is at low risk of extension to a proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) if it:

  • occurs as a complication of intravenous cannulation
  • is located > 3 cm from the deep venous system and is shorter than 5 cm (and the patient has no other VTE risk factors).

Low-risk superficial vein thrombosis does not require anticoagulant therapy, provide symptomatic care including topical or oral non-steroidal anti-inflammatory drug therapy for 7 to 14 days. Consider serial imaging to monitor.

Intermediate- risk superficial vein thrombosis

An isolated superficial vein thrombosis is at an intermediate risk of extension to a proximal DVT or PE if it is located >3 cm from the deep venous system and is longer than 5 cm. Anticoagulant therapy can be used.

High risk superficial vein thrombosis

An isolated superficial vein thrombosis is at high risk of becoming a proximal DVT or PE if it:

  • extends to within 3 cm from the deep venous system
  • spreads despite appropriate anticoagulant therapy for an intermediate-risk superficial vein thrombosis.

Treat patients with an anticoagulant for 3 months.

Clinical 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.