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.

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

Urgent referrals contact Women’s and Children’s Hospital (WCH) Renal Registrar

  • clinical
    • nephrotic syndrome
    • macroscopic haematuria
    • hypertension
  • investigations
    • abnormal renal function
    • nephrotic range proteinuria - Albumin-to-creatinine ratio (ACR) >200mg/mmol or protein-creatinine ratio (PCR) >300mg/mmol

Category 2 (appointment clinically indicated within 90 days)

  • persistent proteinuria for >3months
  • albumin to creatinine ratio >30mg/mmol for 4 weeks

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.

Clinical features

  • reason for referral
  • duration of symptoms
  • details of all treatments offered and tried
  • current medications
  • past medical history
  • relevant family history
  • examination findings including blood pressure, height, weight

Investigations and correspondence

  • relevant recent and past investigations: blood, urine, radiographic studies and reports
  • copies of other relevant letters should accompany the referral

Consent

  • for patients > 16 years old please enquire if they consent to have details shared with parent/guardian

Additional information to assist triage categorisation

Clinical

  • blood pressure
  • skin examination
  • joint examination
  • abdominal examination
  • genital - scrotal examination
  • oedema
  • shortness of breath
  • urine output
  • macrohaematuria

Investigations

  • urine microscopy, culture, and sensitivity (MCS)
  • first morning urine assessment
  • urine protein:creatinine ratio
  • urine albumin:creatinine ratio
  • electrolytes, urea, creatinine (EUC)
  • calcium / magnesium / phosphate
  • liver function test (LFT)
  • complete blood examination (CBE)
  • compliment 3/compliment 4 in antinuclear antibody (ANA) test, antineutrophil cytoplasmic antibodies (ANCA) test

Clinical management advice

Referrals to nephrology should only occur in the setting of renal involvement. If concerns regarding non-renal symptoms of Henoch Schonlein Purpura please contact General Medicine Paediatrics or if significant multi-organ involvement or refractory to standard therapy, contact Rheumatology.

Please contact the Women’s and Children’s Hospital (WCH) on call Renal Doctor for clinical management advice.

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.