Who to refer

GPs may refer any patient presenting with acute, sub-acute or “acute on chronic” clinical presentations where they feel they could benefit from Specialist advice or a 2nd Opinion.
Please note that patients with time-critical emergencies are not appropriate to refer to our service and 000 should be called instead.

Click on the circles for more details.

Who to Refer – Examples

What’s the BEST Antibiotic choice given:

  • Failed 1st line therapy, or
  • Allergies or multiple infections

Systemic Steroids

  • Likely risk vs benefit in this patient?

Anticoagulate or not?

Acute Pain management

  • BEST options/alternative options?

Investigations

  • BEST choice, Urgency, Interpretation
  • MRI referral?
  • ECG Interpretation

Who to Refer – Examples

Diagnostic Dilemmas

Complex Assessments or Complex Management due to:

  • Multiple presenting complaints
  • Acute/sub-acute presentation is complicated by
    • Chronic conditions/co-morbidities
    • Potential medication interactions or allergies
    • Geographic/socio-economic issues

Who to Refer – Examples

Patients in the “grey area” between GP vs hospital for further evaluation or management:

  • Mildly abnormal vital signs
  • Bit unwell
  • May need urgent (vs outpatient) investigation
  • May benefit from from specialist 2nd opinion or ED evaluation

What to refer

Examples of suitable patient presentations to refer to ED4GP include, but are not limited to:

General Advice

  • Complex Assessments
    Examples include patients presenting with symptoms and signs that simply don’t fit into the “usual boxes” or that present with multiple acute complaints that don’t easily link together. Our Specialists are experts in the assessment of such patients.
  • Abnormal Vital Signs
    We can assist in the evaluation and disposition decision for patients with mildly abnormal vital signs.
    Patients with substantial abnormalities in vital signs are generally best transferred to the Emergency Department
  • Treatment Decisions, in the context of your patient
    General Treatment Decisions
    We can assist with optimising the treatment of a variety of acute and sub-acute conditions and help make risk-stratificiation decisions regarding outpatient v inpatient management.
    Antibiotic decisions
    Sometimes antibiotic choices can be difficult due to failure to respond to 1st line antibiotic, patient allergies, multiple sources of infection or questions regarding choice of route (e.g. oral v IV); our Specialists have broad knowledge in this area and can solve most challenging decisions.
    Acute Pain Management
    Our Specialists are experts in acute pain management using multi-modal and condition specific analgesic options to optimise acute relief while minimising opioid use.
  • ECG interpretation, in the context of your patient

    Our Specialists are experts in ECG interpretation, interpreting more ECGs in undifferentiated patients than any other specialty. We can assist in the detection of subtle ECG signs of:

    • Ischaemia which can be particularly useful in patients who present with atypical ACS (acute coronary syndrome) symptoms such as atypical pain, shortness of breath, abdominal pain and acute lethargy/malaise
    • Arrhythmogenesis in patients presenting with syncope, pre-syncope and even simply non-specific dizziness
  • Investigation advice: choice of test, urgency of test and interpretation of results

    Some examples include:

    • Can I ignore a CRP of 60 in this patient or do they need treatment or further evaluation?
    • How should I manage an INR of 9 in this patient?
    • Which is the best first imaging choice for this patient with abdominal pain – U/S or CT?
    • How urgently should this patient be investigated and is it reasonable to investigate as an outpatient?
    • What CT contrast phases should I request to ensure I don’t miss any likely diagnoses in this patient?
    • Acute electrolyte disturbances – causes, investigation, treatment and need for Emergency Department referral?
  • Risk Assessment
    Does my patient require further blood tests or imaging or is it reasonable to simply manage them conservatively in the first instance?
    Does my patient need referral to the ED or is it safe to continue to manage them in my clinic?

Specific Presentations

  • Acute shortness of breath
    Specialist evaluation and assistance with diagnosing and managing patients with acute shortness of breath including acute asthma, exacerbations of COPD, pneumonia and pulmonary oedema.
    Additionally we can risk stratify these patients with to decide on treatment/antibiotic choices and need for admission.
    Please note that patients with severe shortness of breath or with a suspected time-critical emergency should not be referred to our service and 000 should be called.
  • ?Pulmonary Embolism (PE) & Deep Vein Thrombosis (DVT) workup
    Does my patient require workup for PE?
    Many patients with specialist assessment can be clinically excluded from requiring investigation for PE.
    If workup is required, can this be safely performed as an outpatient or does my patient need to go to the Emergency Department? Should I use imaging or d-dimer?
    Many patients with suspected PE and DVT, using specialist risk stratification tools, can be safely investigated as an outpatient, saving a trip to the Emergency Department.
  • Arrhythmias: workup and management in haemodynamically stable patients
    This includes Atrial Fibrillation and deciding whether to choose rhythm vs rate control
  • Syncope
    Specialist evaluation including ECG interpretation to look for subtle signs of arrythmogenesis and decision on whether your patient needs inpatient evaluation or not
  • Dizziness and vertigo
    Specialist evaluation regarding differential diagnosis, most appropriate investigation choices and whether Emergency Department referral required.
  • Acute Paediatrics (> 3 month old)
    We can help with the risk assessment and management of acute paediatric presentations (greater than 3 month of age) such as respiratory complaints (e.g. croup, bronchiolitis, asthma, pneumonia) and the febrile child .
  • Back pain
    Does my patient need imaging, blood tests or Emergency Department referral?
  • Headache
    Does my patient need imaging, blood tests or Emergency Department referral?
  • Injuries: Head, C-Spine and general injury assessment and management

    Does my patient with head or cervical spine injury need imaging or can they be clinically cleared? Our Specialists use evidence-based risk algorithms to allow them to safely avoid imaging in the vast majority of patients.

    Management of soft tissue injuries and diagnosed fractures – does this injury need immobilisation, surgical referral and how urgent is that referral?

  • Febrile patient
    Risk assessment, investigation choice/interpretation, antibiotic decisions and need for Emergency Department referral
  • Infections (e.g. cellulitis, pneumonia …)
    Risk assessment, optimal antibiotic choices and decisions regarding oral vs IV
  • Acute abdominal and pelvic pain
    We can assist with risk assessment and choosing the optimal choice of imaging in the context of your patient
    Often the choice of imaging is critical and sub-optimal choice of imaging or selection of inappropriate contrast phases in CT scans can lead to missed diagnoses.
  • Vomiting and/or Diarrhoea

    Symptom management advice including new evidence based strategies to achieve oral hydration in the community.

    Acute vomiting risk assessment: ?gastro ?occult serious illness.

    Acute diarrhoea risk assessment: ?warranting empirical antibiotics or micro testing ?simple gastro or not

EXCLUSION CRITERIA: Who NOT to Refer

We are unable to provide assistance with patients presenting with:

  • Time-critical emergencies – Call 000
    Unfortunately, while our Specialist are uniquely skilled in this area, we are unable to absolutely guarantee an assessment in a time frame that would not dangerously delay definitive care of true emergencies. Additionally, in this context, there are significant limitations to the quality of care able to be provided via telehealth and patients are generally better served by urgent transfer to an actual emergency department.
  • Chronic presentations (except “acute on chronic” exacerbations)

    Our Specialists are not specialists in chronic presentations. We can provide expert assistance with acute, sub-acute and “acute on chronic” presentations.

  • Mental Health presentations
    Our Specialists are unable to add particular expertise in this area. If additional assistance is required, we would advise contacting your local Mental Health services.
  • Obstetric >20/40 gestation & Infants <3/12 old

    For pregnant patients with gestations > 20 weeks, the limitations of telehealth would prevent our Specialists from providing additional benefit to GPs in this area and we would advise consultation with your local Obstetric service.
    Infants under 3/12 are inherently high risk and are more often subject to routine ED investigation if concerned. Additionally their assessment is more time-critical and relies more heavily on the ability to examine the patient in person, which is not possible by telehealth. We recommend that any infants under 3/12 that GPs are concerned about should be referred directly to the ED.