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.
- hypertension - >95th percentile + 20mmHg for height, age and gender, see Screening Blood Pressure Values in Children That Need Additional Evaluation
- oliguria or anuria
- hyperkalaemia > 5mmol/L in a non-haemolysed sample
- macroscopic haematuria or proteinuria >200mg/mmol
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant specialty service.
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 (appointment clinically indicated within 30 days)
- creatinine > twice the upper normal limit
- proteinuria – protein to creatinine ratio > 20mg/mmol – 200mg/mmol
Category 2 (appointment clinically indicated within 90 days)
- mild chronic kidney disease (CKD)
Category 3 (appointment clinically indicated within 365 days)
- elevated creatinine
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
- 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
- evidence of oedema
- urine microscopy, culture, and sensitivity (MCS)
- urine protein to creatinine ratio
- urine albumin to creatinine ratio
- electrolytes, urea, creatinine (EUC)
- calcium, magnesium, phosphate
- liver function test (LFT)
- full blood examination (FBE)
- renal ultrasound
Clinical management advice
Please phone the on call Renal Doctor via Women’s and Children’s Hospital (WCH) switchboard on (08) 8161 7000 for clinical management advice, especially if you are unsure if your patient needs a referral to emergency.
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.