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.
The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation
- Acute cervical myelopathy
- Acute back or neck pain secondary to neoplastic disease or infection
- Spinal injuries
- Suspected open fracture
- Fracture requiring manipulation or operation
- Suspected acute bone or joint infection
- Acute high energy fracture with/without neurological abnormality
- Injury associated with vascular compromise
- Clavicle fracture
- Osteoporotic / pathological fracture new abnormal neurology
- Suspected infection or sudden pain in arthroplasty
- if joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call
- do not commence antibiotics unless delay to specialist review is likely
- Joint dislocations
- Open injuries with possible tendon or joint involved
- Nail bed injuries or retained foreign body
- Knee extensor mechanism rupture
- Acute peripheral nerve injury
- Suspected acute compartment syndrome
Spine, Neck, Back Pain
NB: contact the Orthopaedic Registrar on 3810 1111. For Neurosurgery and Spine conditions please call the Neurology or Spinal Registrar at The Princess Alexandra Hospital on 3176 2111.
- High risk of irreversible deficit if not assessed urgently
- Spinal infections
- Significant spinal nerve root compression or spinal cord compression with progressive neurological signs/symptoms e.g.
- Spinal cord compression with severe or rapidly progressing neurological deficit
- Cauda equina syndrome
- Bilateral nerve pain (leg pain below knees)
- Bladder / bowel dysfunction
- Perineal anaesthesia
- Progressive weakness
- Bone infection
Refer to HealthPathways or local guidelines
- Determine the potential for underlying sinister pathology
- Concerning features
- Age (at onset) < 16 or > 50 with new onset pain
- Motor deficit e.g. foot weakness
- Recent significant trauma
- Weight loss (unexplained)
- Previous history malignancy (however long ago)
- History of IV drug use
- Previous longstanding steroid use
- Recent serious illness
- Recent significant infection
- Most Category 2 and 3 patients referred for a surgical opinion do not require surgery. Evidence demonstrates that non-surgical management is as effective for a number of spinal conditions.
- Appropriate category 2 and 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist. Outcomes may include provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon or discharge.
Management
- Caution should be used in prescribing opiates for spinal pain which should be prescribed in line with current guidelines
- Advice, education and reassurance
- Heat, activity modification, normal activity
- Physiotherapy and exercise
- Anti-inflammatory and analgesia may be considered
- Complete ‘Keele STarT Back’ screening tool to identify risk of developing chronic spinal pain [2, 6]
- Low to medium risk suggests ongoing management in primary care maybe appropriate
- Imaging of the spine is not recommended in most patients with an acute presentation or with a stable chronic presentation unless there is the indication of sinister or serious pathology (concerning features). If there are no signs of sinister or serious pathology, imaging may be indicated after a trial of conservative therapy. (Imaging pathways)
Patient resources
- Chartered Society of Physiotherapy: 10 things you need to know about your back
- Qld Health Emergency Department Fact Sheet
West Moreton Health service does not currently have a dedicated Spinal Service. Please send referral to Metro South Health Service for review.
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Category 1 |
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| Category 2 (appointment within 90 calendar days) |
Appropriate category 2 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician
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| Category 3 (appointment within 365 calendar days) |
Appropriate category 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician
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If your patient does not meet the minimum referral criteria
- Consider other treatment pathways or an alternative diagnosis
- If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
Patient's Demographic Details
- Full name (including aliases)
- Date and country of birth
- Residential and postal address including whether patient resides at an aged care facility
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Name of delegate and contact details (Department of Corrective Services)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Any special needs, access requirements and/or disability relevant to the referral
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- All conservative options that have been pursued unsuccessfully prior to referral
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
- Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living functioning – low/medium/high
- 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
Essential referral information - Please refer directly to Metro South Health
Without this information the referral will be returned
- Presence and duration of neurological signs and symptoms
- Presence or absence of concerning features
- Age (at onset) < 16 or > 50 with new onset pain
- Motor deficit e.g. foot weakness
- Recent significant trauma
- Weight loss (unexplained)
- Previous history malignancy (however long ago)
- History of IV drug use
- Previous longstanding steroid use
- Recent serious illness
- Recent significant infection
- Mechanism of injury
- Functional status
- Management to date (including previous spinal surgery and non-operative management)
- General medical history
- Relevant imaging results (may include plain x-ray, CT and MRI)
- Other relevant reports from any providers in a public or private sector related to the presenting problem
- FBC, ELFT, ESR, CRP results, rheumatoid serology, Calcium and phosphate, electrophoresis, immunoglobin’s, PSA (if relevant)
- For any lumbar spondylolisthesis plain lateral standing films in flexion and extension are helpful in addition to the CT/MRI
- Spinal referral questionnaire
Clinical override of referral criteria may be requested in the following situations:
- Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
- Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
- Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.
Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.
Out of catchment
West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.
Feedback
To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.