Complex or undifferentiated medical problems

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:

  • 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

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Unstable co-morbidities which require early medical intervention to prevent further deterioration that may result in emergency hospitalisation
  • Recent discharge from hospital or emergency department (<4 weeks) and need for ongoing surveillance and optimisation of co-morbidities
  • Acute exacerbation of chronic medical condition which impacts on other co-morbidities and requires close monitoring
  • Rapidly progressive or recent onset of undifferentiated syndromes (eg pyrexia [T<39°C] of unknown origin, marked decline in cognitive function, generalised sub-acute myalgia/arthralgia or other undifferentiated rheumatic syndromes, generalised lymphadenopathy) for which definitive diagnosis and/or management plan is required
  • Fatigue lasting more than 3 months and any of the following:
    • significant weight loss (≥5% body weight in previous 6 months)
    • recent and/or progressive onset in previously well, older patient
    • dyspnoea or other features suggestive of cardiorespiratory compromise
    • unexplained lymphadenopathy
    • presence of fever

Category 2

Appointment within 90 days is desirable

  • Stable co-morbidities that require risk assessment and medical optimisation
  • Stable or slowly progressive undifferentiated syndromes (eg fatigue, decline in cognitive function, generalised lymphadenopathy) for which definitive diagnosis and/or management plan is required
  • Chronic symptoms (eg dyspnoea, dizziness, imbalance) or condition requiring investigations and management to minimise long term impairment
  • Chronic symptoms causing significant social/economic/functional impairment
  • Diagnostic dilemmas requiring further investigation or confirmation
  • Connective tissue disease which is active but not life threatening
  • Polymyalgia rheumatica (PMR)

Category 3

Appointment within 365 days is desirable

  • Multiple co-morbidities in need of regular review where referral to two or more specialty clinics imposes an unacceptable burden on patients
  • Soft tissue rheumatism
  • Non-progressive fatigue lasting longer than 3 months that remains unexplained despite detailed investigation

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

Other important information for referring practitioners

Not an exhaustive list

  • Laboratory tests should be limited and dependent on the history and examination.
  • Available depression tools include:
    • PHQ-2 – 2 question screening tool
    • K-10 – 10 question screening tool
  • Consider referral to dietitian if significant weight loss reported.
  • Refer to HealthPathways for assessment and management information if available

Referral requirements

A referral may be rejected without the following information.

  • Relevant medical history, co-morbidities (including depression and anxiety) and medications (including an assessment of adherence)
  • Details of all treatments offered and assessment of efficacy
  • A clear indication of clinical question that the specialist is required to address
  • Details of any functional decline or cognitive impairment
  • FBC, ELFT, ESR & TSH results

In cases of suspected malignancy, pyrexia of unknown origin or generalised lymphadenopathy, also include:

  • CT scan chest/abdomen/pelvis
  • ANA plus full antibody profile if ANA > 1/640
  • Serum protein electrophoresis

In cases of myalgia/arthralgia, also include:

  • CPK results
  • ANA plus full antibody profile if ANA > 1/640

In cases of poorly controlled diabetes, also include:

  • HbA1c

In cases of suspected rheumatological or systemic inflammatory conditions, also include:

  • CRP, Rheumatoid factor & ANA results

In cases of suspected or known cardiorespiratory disease, also include:

  • CXR

In cases of unexplained fatigue of recent onset, also include:

  • Impact on daily life and work (including falling asleep while driving)
  • CXR
  • Urinalysis results
  • Calcium, ESR/CRP, iron studies, CPK (if muscle weakness or pain), vitamin B12 & folate results

In cases of cognitive decline, also include:

  • Vitamin B12 and folate
  • Urine m/c/s
  • CT head

Additional Referral Information (Useful for processing the referral)

  • Existing psychosocial issues and supports
  • Copies of discharge summaries and outpatient letters relating to encounters with other specialists
  • ECG
  • BNP (if available)
  • Magnesium and phosphate results (if appropriate)
  • Documentation relating to past hospitalisations and clinic visits for anxiety/depression (if appropriate)
  • Background information on occupational history and past infectious diseases (if appropriate)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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
  • 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
  • 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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • 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
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • 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.)