Syncope / pre-syncope
+ 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
+ Useful management information
- If syncope thought likely to be of of cardiac origin see Cardiology CPC (coming soon).
- If possible please identify an eye witness to any episode of syncope and request that the witness attends the specialist outpatient appointment with the patient.
+ Minimum referral criteria - Does your patient meet the minimum referral criteria?
|
Category 1 |
|
| Category 2 (appointment within 90 calendar days) |
|
| Category 3 (appointment within 365 calendar days) |
|
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
+ Standard referral information To be included in all referrals
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
- A comprehensive capture of information in relation to MSH Referral Criteria
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 informationWithout this information the referral will be rejected
|
+ Additional referral information
- Any investigations relevant to co-morbidities (eg HbA1c if diabetic, spirometry if COPD)
- EEG results (if available)
- Holter monitor or event monitor results (if available)
- Echocardiogram results (if available)
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: Thursday, November 1, 2018
