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General Medicine


+ 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.

Anaemia

  • Severe anaemia (Hb <80g/L) with risk of cardiovascular and/or syncopal collapse
  • Anaemia associated with definite clinical features of overt gastrointestinal bleeding
  • Severe cytopaenias if patient is unwell (ie infection, symptomatic anaemia, active bleeding)
    • Neutrophils < 0.5x109/L
    • Haemoglobin < 80g/L
    • Platelets < 20x109/

Complex or undifferentiated medical problems

  • Any sudden decompensation in clinical condition that carries risk of serious adverse events or death
  • Pyrexia of unknown origin with temp ≥ 39ºC
  • Pyrexia with neutropaenia
  • Delirium
  • Suspected systemic vasculitis associated with symptoms, signs or investigation results suggestive of vital organ involvement
  • Suspected temporal arteritis (giant cell arteritis) with markedly elevated ESR (>100) and/or jaw claudication and/or visual disturbance

Complex paediatric patients transitioning to adult services

  • Any sudden decompensation in clinical condition that carries risk of serious adverse events or death

Falls

  • Any fall occasioning serious trauma (including fractures, major soft tissue injury, head strike or concussion) that cannot be managed in primary care
  • Frequent falls (more than one every few days)

Medication review / poly-pharmacy

  • Anaphylactic or other serious adverse drug event
  • Markedly prolonged heart rate adjusted QT interval which may herald pro-arrhythmic event
  • Marked drug induced electrolyte abnormality (Na <120, K <3.0 or >6.0, corrected Ca >3.0, Mg <0.4)

Osteoarthritis, gout and joint pain

  • Acute non-traumatic monoarthritis causing severe pain and/or incapacitating loss of function and/or marked constitutional symptoms
  • Suspected septic arthritis

States of altered neurological function

  • Witnessed tonic-clonic (grand mal) seizures
  • Suspected transient ischaemic attack or stroke on the basis of focal neurological deficits
  • Delirium or acute confusional state
  • Severe headache or altered level of consciousness of sudden onset

Syncope / pre-syncope

  • Syncope / pre-syncope with any of the following Red flags
    • exertional onset
    • chest pain
    • persistent symptomatic hypotension (systolic BP < 90mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by palpitations
    • associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
    • family history of sudden cardiac death

Unintentional weight loss

  • Uncontrolled hyperthyroidism with risk of thyroid storm
  • Vomiting, dysphagia or odynophagia suggesting oesophageal or gastric outlet obstruction
  • Associated severe electrolyte abnormalities (K+ <3.0 mmol/L, corrected Ca+ <1.6 or >3.0 mmol/L, Mg+ <0.4 mmol/L, PO4- <0.4mmol/L)

Wounds of uncertain cause or non-healing ulcers

  • Severe cellulitis with ongoing or worsening systemic symptoms or fevers despite oral antibiotics for 48 hours
  • Foot ulcer in diabetic patient that is not responding to oral antibiotics and regular wound cleaning
  • Any infected ulcer associated with systemic inflammatory response symptoms (SIRS) or excessive pain or features suggestive of abscess formation, osteomyelitis or deep tissue infection (necrotising fasciitis)
  • Acute Charcot arthropathy
  • Ulcers or wounds in a limb with markedly compromised circulation

Other

  • Any condition defined by other CPCs as requiring referral to emergency

+ Are you referring to the right service?

When referring for falls, cognitive change, mobility changes or movement disorders please consider whether a geriatric review is required. If appropriate address referral to Director of Geriatrics.

+ Urgent referrals

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

Conditions seen at West Moreton Health

Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section. 

+ Out of scope services

The following are not routinely provided in a public General Medicine service.

  • Clearly evident mental health disorders requiring psychiatric consultation
  • Genetic testing / counselling
  • Requests for respite care, ACAT assessments or other forms of assessment or supportive care in the presence of established diagnoses and management plans, or where patients with established mental capacity to make decisions refuse such  assessments or care
  • Reviews relating to workers’ compensation claims, NDIS eligibility, disability pensions, driving license renewals, or other legal and administrative procedures
  • Reviews relating to drug withdrawal or detoxification

+ 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: Tuesday, June 19, 2018

Send referrals to


Templates: Click here for Best Practice referral template

Click here for Medical director referral template


Secure messaging:
Secure web transfer IQ43050005G

General Fax:
38101438

Priority Fax for urgent referrals:
To be determined

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 to: Director of General Medicine.

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)