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 exacerbation with 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
  • altered consciousness.
  • hypoxia (<90% oxygen saturation) when this is not normal for the patient.
  • features of acute intercurrent infection, e.g., fever, pulmonary infiltrate, high-volume purulent sputum
  • new and/or large volume (> 50mL) haemoptysis
  • new chest x-ray (CXR) changes indicative of cavitation, consolidation, or pneumonia

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

  • bronchiectasis (non-cystic fibrosis)
  • chronic suppurative lung disease (CSLD)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • chronic bronchiectasis/CSLD with any of the following:
    • any haemoptysis
    • rapidly worsening symptoms or decreasing exercise tolerance or rapidly worsening
    • pulmonary function tests
    • unintentional weight loss

Category 2 (appointment clinically indicated within 90 days)

  • chronic bronchiectasis/CSLD with frequent (> 3 per year) infective exacerbations despite optimal therapy
  • stable symptomatic chronic bronchiectasis/CSLD 
  • more than 3 to 4 presentations of lower respiratory infections requiring antibiotics in the past 12 months
  • sputum shows Pseudomonas aeuruginosa, atypical mycobacteria or Staphylococcus aurea

Category 3 (appointment clinically indicated within 365 days)

  • asymptomatic newly diagnosed or suspected bronchiectasis/CSLD

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.

  • history of disease including duration, severity and frequency of symptoms and exacerbations
  • associated symptoms, e.g. dyspnoea, cough, haemoptysis, chest pain, leg swelling, weight loss, fevers
  • systemic symptoms
  • co-morbidities
  • any intensive care/high dependency unit admissions
  • assessment for sinus disease and cor pulmonale
  • medications, including previously trialled medications if associated with treatment failure or other problems
  • smoking status
  • history of childhood infections or recurrent respiratory infections
  • sputum microscopy, culture and sensitivity (MCS), fungal culture and sensitivity, nocardia acid fast bacilli (AFB)
  • imaging: chest x-ray (CXR) or high-resolution computed tomography (HRCT) chest
  • bloods results
    • full blood count (FBC)
    • liver function tests (LFTs)
    • urea
    • electrolytes
    • glucose
    • coagulation studies
    • erythrocyte sedimentation rate (ESR)
    • immunoglobulins with IgG sub class results

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number
  • spirometry
  • family history of cystic fibrosis

Clinical management advice

  • consider referral to physiotherapy for consideration of airway clearance
  • antibiotic treatment guided by sputum culture

Clinical resources

Consumer 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.