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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.
- sudden onset claudication or sudden reduction in claudication distance: please contact on call registrar to discuss clinical concerns
- active infection +/- wet gangrene +/- foot ulceration with infection and systemically unwell or febrile, rapidly spreading cellulitis
- active infection in foot +/- leg in patients with known PAD
- active infection in foot ulceration +/- in patients with known diabetes
- acute arterial/limb ischaemia
It is strongly advised that after hours presentations attend the Royal Adelaide Hospital or Flinders Medical Centre emergency departments.
For clinical advice, please telephone the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Category 1 — appointment clinically indicated within 30 days
- peripheral aneurysm ≥ 2 cm
- critical limb threatening ischaemia symptoms including gangrene, ulcer, rest pain
- claudication ≤ 20 m distance
Category 2 — appointment clinically indicated within 90 days
- asymptomatic peripheral aneurysm < 2 cm
- claudication > 20 m and < 200 m distance
Category 3 — appointment clinically indicated within 365 days
- claudication > 200 m and < 500 m distance
- vascular malformation
- vasospastic disorders including:
- Raynaud’s disease
- acrocyanosis
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.
- complete past medical history
- current medication list
- presence/absence pulses: dorsalis pedis/posterior tibial/popliteal
- previous risk factor management - including statin and antiplatelet agents/exercise programs
- claudication walking distance in metres
- rest pain if present
- identifies as Aboriginal or Torres Strait Islander
- smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
- haemodialysis or peritoneal dialysis dependent
- ulcer presentation
- body mass index
Additional information to assist triage categorisation
- complete blood count (CBE)
- urea, electrolytes and creatinine test (UEC)
- liver function tests (LFT)
- estimated glomerular filtration rate (eGFR)
- glycated haemoglobin test (HbA1c)
- Ankle Brachial Pressure Index
- wound microscopy, culture, sensitivity (MCS) (if clinical signs of infection present)
- relevant cardiac investigation reports (if previously completed)
Clinical management advice
- examine both feet for evidence of the following risk factors (consider high risk foot referral):
- neuropathy
- ulceration
- callus
- infection and/or inflammation
- deformity
- gangrene
- non-active Charcot arthropathy
- peripheral pulses foot/ankle/calf
- evidence-based exercise programs are for patients with PAD in lower limbs, and should be encouraged in association with risk factor management in the community
Clinical resources
- Foot Forward
- Royal Australian College of General Practitioners (RACGP) - Smoking Cessation
- RACGP - PAD Diagnosis and Management
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.