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Pleural disorders

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

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Large symptomatic pleural effusion(s)
  • Features of infection/sepsis
  • Acute pneumothorax

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

  • Moderate to large pleural effusion (≥30-50 mm depth on CT chest) without radiological evidence of heart failure
  • CT evidence of malignant process (localised pleural thickening or chest wall invasion on imaging)

Category 2

Appointment within 90 days is desirable

  • Progressive pleural thickening on serial imaging
  • Localised pleural thickening of >20 mm
  • Persistent small to moderate pleural effusion (10-30 mm) depth on CT chest)

Category 3

Appointment within 365 days is desirable

  • Chronic, stable pleural processes with symptoms

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

  • Refer to HealthPathways or local guidelines
  • Radiological thoracocentesis prior to physician review is not recommended
  • Pleural effusions due to heart disease can be unilateral. Consider left heart failure as a cause of any pleural effusion(s).
  • Pleural plaques without other radiological abnormalities (such as interstitial lung disease) do not require specialist review. Most international guidelines recommend no regular follow up or, most conservatively, annual CXR.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • History of occupational exposure (e.g. asbestos) or TB exposure
  • Results of any previous pleural procedures
  • CT chest

Additional referral information (Useful for processing the referral)

  • FBC, ELFT

 

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.)
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