High Risk Foot - Vascular Surgery
Emergency department referrals
All urgent cases must be discussed with the on call Vascular Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.
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, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- Active infection in leg with peripheral arterial disease
- Diabetic foot infection (refer to high-risk foot pathway)
- Acute arterial ischemia/threatened limb
- Foot ulcer with infection and systemically unwell or febrile, invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm), acute ischaemia, wet gangrene, acute or suspected Charcot
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
- Arterial foot ulcer with mild to moderate infection <2cm around wound
- Necrosis/dry gangrene (with or without ulceration)
Category 2
Appointment within 90 days is desirable
- Non-infected neuropathic ulcer with palpable pedal pulse
- Chronic venous ulcer
Category 3
Appointment within 365 days is desirable
- High Risk Foot (IWGDF Risk Stratification): Loss of protective sensation (LOPS) or Peripheral artery disease (PAD), and one or more of the following:
- History of foot ulcer
- A lower extremity amputation (minor or major)
- End-stage renal disease
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
- Diabetic foot ulcer: High-risk foot clinic (referral via podiatry and access via telehealth available –- Statewide Diabetes Clinical Network will provide details)
- For adults with diabetes, assess their risk of developing a diabetic foot problem at the following times:
- when diabetes is diagnosed, and at least annually thereafter
- if any foot problems arise
- on any admission to hospital, and if there is any change in their status while they are in hospital.
- For low risk of developing a diabetic foot problem, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk
- Basic foot care advice and the importance of foot care
- ATSI people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
- Commence antibiotics as per therapeutic guidelines https://tgldcdp.tg.org.au/etgAccess
Off-loading https://www.sdc.qld.edu.au/courses/176 - Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general diabetic population, which in turn is 15 times the rate in people without diabetes
- Advance Health Directive
Examine both feet for evidence of the following risk factors:
- Neuropathy (use a 10g monofilament as part of a foot sensory examination)
- Limb ischaemia (see CPC on peripheral arterial disease)
- Ulceration
- Callus
- Infection and/or inflammation
- Deformity
- Gangrene
- Charcot arthropathy
Deadly Feet Program
Deadly Feet is a multi-disciplinary service providing early assessment, risk modification, and specialist intervention for Aboriginal and Torres Strait Islander people at risk of lower limb conditions associated with diabetes and/or peripheral vascular disease. Patients are reviewed by a vascular consultant, a specialist vascular sonographer, and a podiatrist within one 90 minute appointment in the Deadly Feet clinic at Redcliffe Hospital, Caboolture MATSICHS or Galangoor Duwalami Primary Healthcare Service, Hervey Bay.
Deadly Feet offers relaxed referral criteria to support equitable access to health care for Aboriginal and Torres Strait Islander people. Referrals can be made through GP Smart Referrals and no prior pathology or medical imaging are required. Alternatively referrals can be made by contacting the Deadly Feet project team by phone on 07 3647 1500 or at MNVOP@health.qld.gov.au.
Referral requirements
A referral may be rejected without the following information.
- Is there active infection? Consider deep wound swab/pathology for culture, ESR CRP FBC
- Is there invasive infection with spreading cellulitis around the wound?
- Details of all treatments offered and efficacy
- Peripheral pulses, femoral/popliteal/foot
- Is the ulcer neuropathic or ischaemic (or both) in origin?
- Duplex scan if suspected arterial disease
- Appropriate medical history including claudication distance, rest pain, ischaemic changes and risk factors
Additional referral information (useful for processing the referral)
- XR if suspected bony involvement
- If suspected arterial disease –Doppler Ankle Brachial Pressure Index (ABPI), toe pressures
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.)
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