Referral to 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.

  • if confirmed or suspected tuberculosis, please phone the tuberculosis team, see Contacts for Clinical Advice

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

  • Royal Adelaide Hospital

Inclusions

  • suspected tuberculosis (TB):
    • new lung infiltrate
    • positive laboratory result for TB
    • pleural effusion in a patient with TB risk factors
    • granulomatous inflammation on tissue biopsy in a person with TB risk factors
  • assessment of TB risk for occupational or medical reasons

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • proven or suspected active pulmonary TB

Category 2 (appointment clinically indicated within 90 days)

  • assessment of TB risk for occupational or medical reasons

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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. Referral letters with attached investigations results can be emailed to health.rahthoracicmedicine@sa.gov.au.

  • duration and severity of symptoms
  • associated symptoms - dyspnoea, cough, chest pain, weight loss, night sweats
  • systemic symptoms
  • tuberculosis (TB) risk factors
    • recent immigrants, refugees or recent travel to endemic areas, particularly Asia,Southeast Asia, Africa, Aboriginal or Torres Strait Islander patients
    • known TB contact
    • human immunodeficiency virus (HIV) positive, acquired immunodeficiency syndrome (AIDS) positive or other immunosuppression
    • alcohol or drug abuse
    • exposure to hospitals or prisons
    • health care worker in TB
  • chest x-ray (CXR)
  • sputum x3 early morning for Acid-Fast Bacilli (AFB) microscopy and culture
  • histology results if tissue (e.g. lymph node) biopsies performed

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number
  • desired or required start date of work, medication or study

Clinical management advice

Seek urgent advice from the Chest Clinic or on-call Thoracic Registrar. The patients with sputum smear positive for Acid-Fast Bacilli (AFB) or suspected to be infectious (signs and symptoms including chronic cough, fever, night sweat, unexplained weight loss, cavitation on chest x- ray/computed tomography (CT),) advise to wear a surgical mask, stay away from work, limit social contacts.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • 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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • 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 pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.