Wounds of uncertain cause or non-healing ulcers

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.

    • 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 syndrome (SIRS) symptoms, 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
    • Refer to local HealthPathways or local guidelines
    • Consider referral to Occupational Therapy for compression garments (not for arterial ulcers)
    • Consider referral to a podiatrist or high-risk foot clinic for assessment and wound care of foot/ankle wounds
    • Consider referral to a dietitian to optimise nutritional status for wound healing or to improve blood glucose control if the patient has diabetes.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Wound or ulcer of uncertain aetiology that is progressing in size despite adequate dressings and leg elevation
  • Uncomplicated foot ulcer of recent onset in diabetic patient
  • Acute onset varicose or arterial ulcer
  • Acute onset ulcer in patients receiving high dose steroids or immunosuppressive agents
Category 2
(appointment within 90 calendar days)
  • Subacute or chronic ulcer of uncertain aetiology that is not responding to appropriate treatment
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

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, comorbidities (particularly diabetes, neuropathy, peripheral arterial disease, cognitive impairment, drug abuse, mental health problems) and medications
  • Wound history including:
    • duration
    • description and size
    • wound initiating event
    • presence of peripheral pulses if limb wound
  • Investigations (if performed)
    • any biopsies of the wound
    • for leg ulcers, include:
      • arterial studies / Ankle Brachial Pressure Index
      • venous incompetence studies (note NOT venous ultrasound for acute DVT)
  • Treatment history - including
    • wound care provided to date (including antibiotics, topical ointments, etc)
    • service provider (i.e. GP, practice nurse or domiciliary nursing service)
  • FBC

3. Additional referral information Useful for processing the referral

  • Residential status (lives alone, support networks, etc)
  • Access to wound care services, domiciliary nursing
  • Smoking status
  • Nutritional status / dietary intake
  • HbA1c / blood glucose control (if patient has diabetes)

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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