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Diabetes and Endocinology


+ 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.

Adult conditions

Pancreatic disease

  • Diabetic ketoacidosis  - A
  • Acute severe hyperglycaemia
  • Acute severe hypoglycaemia - A
  • Hyperosmolar hyperglycaemic state (HHS) - A
  • Newly diagnosed type 1 diabetes – B (call registrar or consultant on call)
  • Foot ulcer with infection and systemically unwell or febrile
  • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
  • Acute ischaemia - A
  • Wet gangrene - A

Urgent cases – (refer to key below)
A – client to present to emergency department immediately
B – client to present to diabetes specialist service within 24 hours.  If no specialist service is available, present to an emergency department.

High Risk Foot

  • Foot ulcer with infection and systemically unwell or febrile
  • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
  • Acute ischaemia
  • Wet gangrene - Refer directly to Princess Alexandra Hospital (PAH) urgently
  • Acute or suspected Charcot - please see "Are you referring to the right service?"

Thyroid disorders

  • Hyperthyroidism complicated by cardiac, respiratory compromise or other indications of severe illness (fever, vomiting, labile blood pressure, altered mental state)
  • Neutropenic sepsis in patient taking carbimazole or propylthiouracil
  • Hyperthyroidism with hypokalaemia or paralysis
  • Suspected myxoedema coma (altered consciousness, hypothermia, fluid overload, bradycardia, hyponatraemia)
  • Stridor associated with a thyroid mass
  • Possible tracheal or superior vena cava obstruction from retrosternal thyroid enlargement

Adrenal disease

  • Addisonian crisis
  • Suspected or confirmed acute adrenal insufficiency
  • Phaeochromocytoma in crisis with uncontrolled hypertension
  • Malignant hypertension

Pituitary disorders

  • All patients with visual field loss (usually temporal and classically bitemporal superior quadrantopia / hemianopia)
  • Pituitary tumour with severe headache
  • Pituitary tumour with evidence of symptomatic cortisol insufficiency
  • Hyperprolactinaemia with visual impairment or other neurological signs

Calcium, electrolyte and metabolic bone disorders

  • Acutely symptomatic hypocalcaemia (e.g. tetany) with serum calcium <2.0mmol/L
  • Severe symptomatic hypercalcaemia (usually serum calcium > 3.0 mmol/l)
  • Hypernatraemia or hyponatraemia with acute confusion/delirium
  • Suspected or confirmed diabetes insipidus with hypernatraemia

Paediatric Conditions

Paediatric diabetes

  • New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
  • Ketoacidosis in a known diabetic with any of the following
    • systemic symptoms (fever, lethargy) or
    • vomiting or
    • inability to eat (even if not vomiting) or
    • abdominal pain or
    • headache

Growth failure

  • Suspected pituitary mass (visual field loss/CNS signs)
  • Addisonian crisis (including unexplained hyponatraemia & hypoglycaemia)
  • Myxoedema coma
  • New onset diabetes insipidus (including unexplained hypernatraemia)
  • Hypocalcaemia (including acute rickets) with seizures

+ Are you referring to the right service?

  • If referring for high risk foot clinic including suspected Charcot foot please phone the Podiatrist on call via switch 3810 1111 or submit urgent referral to High Risk Foot Clinic.
  • If Acute Charcot (red, hot, swollen foot) is suspected, an urgent referral should be made to Ipswich Hospital high risk foot clinic for immobilisation/ further assessment
  • Private Diabetes Educators may be accessed through Enhanced Primary Care Plan
  • Diabetes QLD (DESMOND) ( http://www.diabetesqld.org.au/managing-diabetes/type-2-diabetes/services-and-programs/desmond.aspx ) provides many group education services for patients managed by their GP
  • West Moreton Health offers a drop in diabetes educator service at the Ipswich Health Plaza.

+ Urgent referrals

To request an urgent outpatient appointment, please phone the Ipswich hospital’s switchboard on 3810 1111 and ask to speak to the Diabetes and Endocrinology Registrar on-call.

Conditions seen at West Moreton Health

+ Out of scope services

The following are not routinely provided in a public Diabetes and Endocrinology service.

  • Pre-diabetes
  • Stable, well-controlled type 2 diabetes
  • Newly diagnosed type 2 diabetes and not acutely unwell
  • Referrals where the primary problem requiring attention is not directly related to the diabetes and should be directed to another speciality service e.g. chest pain for investigation should go to cardiology
  • Dietary advice for weight reduction, high cholesterol, hypertension or CVD in patients with diabetes
  • Newly diagnosed primary hypothyroidism, including subclinical hypothyroidism – Note: in women of child bearing age who are pregnant or wishing to become pregnant or not using contraception, thyroxine should be commenced and titrated, aiming for a TSH less than 2.5
  • Positive thyroid antibodies with normal thyroid function
  • Osteopaenia
  • Routine uncomplicated osteoporosis

+ Notes

  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • 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.

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.



Last updated: Monday, August 13, 2018

Send referrals to


Secure messaging:
Secure web transfer IQ43050005G

General Fax:
3810 1438

Priority Fax for urgent category 1 referrals:
3413 7277

Post:
Outpatients Referrals Centre
PO Box 73, Ipswich
Queensland, 4305

Patient Enquiries:
3810 1217

GP/Specialist Referral Enquiry:
3810 1869 or 3810 1858


Named referrals

If you would like to send a named referral, please address it to the specialist on the referral template, who will allocate a suitably qualified specialist to see the patient.

From July 1 2017 Commonwealth growth funding has been capped. This changes how WMHS can fund its growth as an organisation. Named referrals from GP’s help support hospital funding through a Medicare bulk-billing arrangement. The new federal funding model incorporates specific pricing for patients which removes concerns around ‘double dipping'. This benefits hospital and patient services.


Patient must bring

  • Medicare card
  • Any concession cards (e.g. Pension, Health Care, DVA, PBS Safety Net, ADF, etc)