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.

  • acute exacerbations, newly diagnosed, suspected or known interstitial lung disease with severe or class 4 dyspnoea or acute respiratory distress/acute respiratory failure
    • suspected or known respiratory disease presenting with:
      • imminent cardiorespiratory arrest
      • anaphylaxis or angiooedema
      • acute onset or worsening of breathlessness
      • confusion, drowsiness, very fast or very slow breathing, not able speak in full sentences at rest due to breathing difficulty, significant increase in the use of accessory muscles of respiration (e.g. neck muscles), cyanosis
      • finger pulse oximetry (SpO2) < 90% if this is not normal for the patient or significant worsening of the patient’s baseline SpO2
      • new onset low blood oxygen or high blood carbon dioxide level, or significant worsening of blood oxygen or carbon dioxide level from the patient’s baseline, if arterial blood gas results are available
    • these signs/symptoms/parameters may be accompanied by a high heart rate or blood pressure changes, significantly higher or lower than the patient’s baseline
  • suspected or diagnosed sarcoidosis with any of the following concerning features:
    • new arrhythmia/chest pain
    • hypercalcaemia with acute kidney injury

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

  • Flinders Medical Centre, request Respiratory Consults Registrar (08) 8204 5511

Inclusions

  • idiopathic interstitial pneumonias e.g. idiopathic pulmonary fibrosis
  • diseases secondary to identifiable or suspected exposures e.g. Hypersensitivity Pneumonitis
  • connective tissue disease-associated interstitial lung disease (CTD-ILD)
  • sarcoidosis

Exclusions

Patients with persistent small focal ground glass opacities may have adenocarcinoma-in-situ rather than interstitial lung disease. The natural history of this condition is long especially if there is no solid component and the lesion is small. It is suggested that such patients are instead referred via the Lung Neoplasia pathway. If there is uncertainty, please contact the relevant Local Health Network for advice, see ‘Contacts for Clinical Advice’.

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • newly diagnosed or suspected Interstitial Lung Disease (ILD) with class 2 to 3 dyspnoea
  • known ILD with worsening hypoxemia or right heart failure
  • known, suspected or rapidly progressive sarcoidosis or sarcoidosis complicated by any of the following concerning features:

Category 2 (appointment clinically indicated within 90 days)

  • chronic ILD with class 1 dyspnoea
  • newly diagnosed or suspected ILD without symptoms
  • known sarcoidosis with progressive symptoms
  • suspected sarcoidosis

Category 3 (appointment clinically indicated within 365 days)

  • known ILD with stable symptoms requiring specialist opinion
  • known sarcoidosis requiring specialist review

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.

  • a summary of the clinical features of the case including relevant history, examination and investigation findings as well as any prior treatment, noting the points below in additional information
  • imaging results: all patients with suspected interstitial lung disease should undergo a high resolution computed tomography (HRCT) chest, and organising this before their specialist consultation will expedite their respiratory care

Additional information to assist triage categorisation

  • details of diagnosis, including relevant previous investigations
  • duration and severity of respiratory symptoms
  • systemic symptoms
  • co-morbidities, particularly connective tissue disease and malignancy
  • medications
  • smoking and drug history
  • occupational and environmental exposures, e.g. pets, bird products
  • family history, especially first and second-degree relatives with interstitial lung disease
  • travel history
  • bloods
    • full blood count (FBC)
    • electrolytes
    • calcium
    • erythrocyte sedimentation rate (ESR)
  • chest x-ray (CXR), high-resolution computed tomography (HRCT) chest
  • if available:
    • rheumatoid factor (RF), antinuclear antibody (ANA), extractable nuclear antigen (ENA), antineutrophil autoantibodies (ANCA) titres/connective tissue disease screen
    • avian precipitating serum antibodies, if bird contact
    • urinalysis
    • SpO2
    • electrocardiogram (ECG)
    • detailed lung function including spirometry, gas transfer, lung volumes, can be organised with appointment if required

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.