Complex or undifferentiated medical problems

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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
    • Refer to local HealthPathways or local guidelines
    • 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.
    • Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: consider requesting General Medicine Assessment. Early management is critical to better health and well-being.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • 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 (e.g. 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

    * If further deterioration in symptomatology; these unstable patients should present to the nearest Emergency Department without delay; and not wait for their Cat 1 clinic appts
Category 2
(appointment within 90 calendar days)
  • Stable co-morbidities that require risk assessment and medical optimisation
  • Stable or slowly progressive undifferentiated syndromes (e.g. fatigue, decline in cognitive function, generalised lymphadenopathy) for which definitive diagnosis and/or management plan is required
  • Chronic symptoms (e.g. 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)
  • Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME-CFS): If there is significant uncertainty about the diagnosis
Category 3
(appointment within 365 calendar days)
  • 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
  • Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
  • Fibromyalgia

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Relevant medical history, co-morbidities (including depression and anxiety)
  • Medications (including over the counter (OTC) and complementary medications, and an assessment of adherence)
  • Details of all treatments offered and assessment of efficacy
  • Clinical question that the specialist is required to address
  • Details of any functional decline or cognitive impairment
  • FBC, ELFT, ESR & TSH

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

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

In cases of myalgia/arthralgia, also include:

  • Creatinine Phosphokinase (CK)
  • ANA plus full auto-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

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, CK (if muscle weakness or pain), vitamin B12 & folate

3. 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 (If available)
  • ECG
  • BNP (if available)
  • Magnesium and phosphate (if indicated)
  • Documentation relating to past hospitalisations and clinic visits for anxiety/depression (if available)
  • Background information on occupational history and past infectious diseases (if appropriate)

4. Request

  • Patient's Demographic Details

    • 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • 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

    Reason for request

    • 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

    Clinical modifiers

    • 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

    Other relevant information

    • 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.)

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

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 January 2025

© State of Queensland (Queensland Health) 2023

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