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.
Respiratory
- Asthma, stridor and wheeze
- infants who have apnoea or cyanosis during paroxysms of coughing
- children with recurrent or persistent respiratory symptoms who have had an episode of choking
- suggestive of a possible inhaled foreign body
- recent onset or escalating stridor and respiratory distress
- acute respiratory distress not responding to home management
- acute respiratory symptoms causing inability to feed or sleep in an infant
NB: Some services children may be directed to and seen by nurse practitioners or advanced practice nurses
- The Asthma Foundation provides a support service with education and spacer devices. Call 1800 ASTHMA (1800 278462).
- Consider referral to an asthma educator or a community asthma nurse:
- newly diagnosed asthma
- poorly controlled asthma
- severe asthma e.g. requiring PICU
- compliance issues
- concerns regarding home management
- patients from a non-English speaking background
- Australian Asthma Handbook from the National Asthma Council: http://www.asthmahandbook.org.au/
- Australian Society of Clinical Immunology and Allergy: http://www.allergy.org.au/
- If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: https://www.communities.qld.gov.au/
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Category 1 |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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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
Without this information the referral will be returned
- General referral information
- Current assessment of asthma control: good, partial, poor
- Current medications
- Frequency of oral steroid use in the previous 3 months
- Note if the child has been hospitalized or not, and how often
- Report presence or absence of Red flags
Presence of Red flags- Paediatric ICU admission
- History of chronic lung disease
- Extreme prematurity
Highly desirable information – may change triage category
- Note symptom frequency over the last 3 months:
- every day
- episodes of wheeze every week but not every day
- episodes every month but not every week
- episodes less than once per month
- Height/weight/head circumference and growth charts with prior measurements if available.
- Presence or absence of sleep, feeding or exercise related symptoms.
- Copy of asthma management plan, if applicable
Desirable information- will assist at consultation
- Assessment of adherence to medication
- History of allergic/atopic disease (and family history of same)
- Other past medical history
- Immunisation history
- Developmental history
- Medication history
- Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
- Other physical examination findings inclusive of CNS, birth marks or dysmorphology
- Any relevant laboratory results or medical imaging reports, urinalysis result
- Spirometry Reports, if available in children able to perform test (children over 8)
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.