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.

  • severe hypertension (> 180/110mmHg) with any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain

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

Category 1 (appointment clinically indicated within 30 days)

  • persistent severe hypertension (> 180/110mmHg but below 220/140mmHg) without emergency referral concerning features

Category 2 (appointment clinically indicated within 90 days)

  • suspected or confirmed renal artery stenosis
  • patients with resistant hypertension and not achieving blood pressure target despite three or more antihypertensive medications including a diuretic especially in the context of chronic kidney disease (CKD)

Category 3 (appointment clinically indicated within 365 days)

  • patients with uncontrolled hypertension and CKD that are not achieving blood pressure target and do not meet criteria for acute kidney injury or CKD
  • hypertension without clear diagnosis

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.

Ideally, pathology should be repeated up to one week prior to scheduled appointment with Nephrologist. Please instruct your patient to do this and provide the necessary pathology forms (repeat electrolytes, urea and creatinine (EUC) and complete blood examination (CBE) at a minimum).

Clinical features

  • reason for referral
  • current medications and 6 month medication history, relevant to renal disease
  • past medical history: cardiovascular disease, diabetes mellitus, hypertension (include historical blood pressure readings), medical comorbidities, family history, previous medical reactions and allergies

Investigations and correspondence

  • history of blood pressure measurements including 24-hour measurements or home measurements if available
  • all recent and relevant past kidney function tests;
    • electrolytes, urea and creatinine (EUC)
    • complete blood examination (CBE)
    • C-reactive protein (CRP), optional
    • liver functions tests (LFT)
    • urine microscopy, culture and sensitivities (MCS)
    • urine albumin/creatinine ratio (ACR) – ideally first void early morning
    • imaging - ultrasound of kidneys, ureters and bladder
    • serial urea, creatinine and estimated glomerular filtration rate (eGFR) results demonstrating abnormal eGFR over at least three months
  • copies of other relevant letters should accompany the referral

Additional information to assist triage categorisation

  • any investigations relevant to co-morbidities or where results exclude other secondary causes - sleep study, endocrine tests
  • computed tomogrpahy (CT) renal and adrenals
  • electrocardiogram and echocardiogram results

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.