General Medicine
Conditions
Please note this is not an exhaustive list of all conditions for General Medicine outpatient services and does not exclude consideration for referral unless specifically stipulated in the out-of-scope section.
- Anaemia
- Chronic Deep vein thrombosis (DVT)
- Complex or undifferentiated medical problems
- Complex paediatric patients transitioning to adult services
- Falls
- Hypertension
- Medication review / polypharmacy
- Osteoarthritis, gout and joint pain
- Pre-operative medical assessment
- States of altered neurological function
- Syncope / pre-syncope
- Unintentional weight loss
- Wounds of uncertain cause or hard to heal ulcer
- Anaemia
- Chronic Deep vein thrombosis (DVT)
- Complex or undifferentiated medical problems
- Complex paediatric patients transitioning to adult services
- Falls
- Hypertension
- Medication review / polypharmacy
- Osteoarthritis, gout and joint pain
- Pre-operative medical assessment
- States of altered neurological function
- Syncope / pre-syncope
- Unintentional weight loss
- Wounds of uncertain cause or hard to heal ulcer
Emergency department referrals
All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:
- Caboolture Hospital (07) 5433 8888
- Redcliffe Hospital (07) 3883 7777
- Royal Brisbane and Women's Hospital (07) 3646 8111
- The Prince Charles Hospital (07) 3139 4000
Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
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.
- Severe anaemia (Hb 70g/L) with risk of cardiovascular and/or syncopal collapse
- Anaemia associated with definite clinical features of overt gastrointestinal bleeding g. haematemesis or melena
- Severe cytopaenias if patient is unwell (ie infection, symptomatic anaemia, active bleeding
- Neutrophils <0.5×109/L
- Haemoglobin <70g/L
- Platelets < 20×109/L)
- 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
- Patient severely symptomatic e.g., severe swelling or pain.
- Pregnant or given birth within the past 6 weeks
- Present, or suspected, acute iliofemoral or supra-inguinal deep vein thrombosis
- Present or suspected acute axiliary or subclavian vein thrombosis
- Patient severely symptomatic e.g., severe swelling or pain.
- Pregnant or given birth within the past 6 weeks
- Present, or suspected, acute iliofemoral or supra-inguinal deep vein thrombosis
- Present or suspected acute axiliary or subclavian vein thrombosis
- 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)
- Severe hypertension (systolic BP >180) with no know ischaemic heart disease, cardiomyopathy or chronic kidney disease AND any of the following concerning features:
- headache
- confusion
- blurred vision
- retinal haemorrhage
- reduced level of consciousness
- seizures
- proteinuria
- papilloedema
- signs of heart failure
- chest pain
- If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible
- If hypertension service available refer to hypertension service
- 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)
- Acute non-traumatic monoarthritis causing severe pain and/or incapacitating loss of function and/or marked constitutional symptoms
- Suspected septic arthritis
- 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 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
- 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)
- 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
- Any condition defined by other CPCs as requiring referral to emergency
Out of scope services
Not all services are appropriate to be seen in the Queensland public health system. Exceptions can always be made where clinically indicated. The following are not routinely provided in a public General Medicine service.
- Clearly evident mental health disorders requiring psychiatric consultation
- Genetic testing / counselling. See Genetics (General) and Genetic Cancer referral guidelines.
- 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
Intervention criteria
Out of scope for general medicine interventions
Not all services are funded in the Queensland public health system. Exceptions can always be made where clinically indicated. It is proposed that the following are not routinely provided in a public general medicine service:
- Any invasive procedure with exception of paracentesis, thoracocentesis, lumbar puncture, proctoscopy/sigmoidoscopy
- Specialised investigative interventions reserved for subspecialists (e.g. EEG, nerve conduction studies, EMG)
- Some investigative interventions may be provided by general medicine services if local expertise is available (e.g. bone marrow aspiration and trephine, echocardiography)
Specialists list
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org