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R E S P I R AT O R Y M E D I C I N E
National Referral Guidelines
Category Definitions : These are recommended guidelines for health professionals referring patients for assessments/treatment in a HHS.
1. Urgent

- seen immediately or within 1 to 2 weeks

2. Semi - Urgent

- within 2 to 6 weeks

3. Routine

- within 2 to 12 weeks

Immediate and Urgent cases must be discussed with the Specialist or Registrar in order to get appropriate prioritisation and then a referral
letter sent with the patient, faxed or e-mailed. The times to assessment may vary depending on size and staffing of the hospital department.

Note : These guidelines are provided as both symptom and diagnosis based. Where the diagnosis
is not known then the symptom based referral guidelines should be used.

NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE DIAGNOSIS BASED
Diagnosis
Asthma

Information Required

Referral Guidelines

Category

Severity of symptoms, previous
hospitalisation (particularly ICU
admission), oral Prednisone use,
current medications,
occupation.

Admission for acute severe
asthma not responding to GP
treatment, asthma with intercurrent disease (eg
pneumonia).

1.

Urgent

3.

Routine

• Recurrent symptoms
despite standard
treatment

2.

Semi-Urgent

• Features of severe asthma,
eg nocturnal wakening,
frequent courses of
Prednisone, frequent
severe attacks requiring
hospital admission or
recent life-threatening
attack

1.

Urgent/Semi-Urgent

Refer to OP Clinic if:
• Diagnosis uncertain
• Need for hospital based
lung function testing or
asthma education

Bronchiectasis

Chest xray report. Past history
of childhood infections. History
of recurrent chest infections,
haemoptysis. Blood and sputum
test and spirometry results if
available.

All patients with suspected
bronchiectasis should be
referred for baseline
assessment

2.

Semi-Urgent/Routine

COPD

Assessment of severity, degree
of breathlessness, signs and
symptoms of right heart failure,
comorbidity, spirometry, chest
xray, nutritional state,
medications, oximetry.

Admission for acute
exacerbations with
respiratory failure

1.

Urgent

Outpatient assessment for

3.

Routine

Severity of symptoms, chest xray
report, lung function and blood
tests if available.

Refer all cases for assessment
and management

1.

Urgent/Semi-Urgent

Diffuse parenchymal lung
diseases (DPLD) eg
interstitial lung disease






Optimising management
Pulmonary function testing
Nutritional advice
Physiotherapy assessment
Rehabilitation
Oxygen therapy assesment

Version 1 Respiratory Referral Guidelines and Priorisation Criteria • Date: 24/10/2000 • Authorised: Elective Services, HFA

TB smears and cultures if available. eg hypertension. Blood test results including calcium. All suspected cases should be referred 1. chest xray changes. smoking history. malignancy. social circumstances. tobacco and alcohol use. tachypnoea. hypotension. xray changes. including immigrant status. Urgent Pulmonary nodules Smoking history. confusion. All patients with suspected tuberculosis should be referred 1. signs and symptoms of DVT. eg. if any. Urgent/Semi-Urgent/ Risk factors. Treat insomnia and upper airway problems if appropriate. heart diseases. comorbidity such as airway disease. degree of symptoms. including previous surgery. Advise on weight loss. Referral for assessment and management 1. tachycardiac 1. Refer for outpatient assessment 2. Refer for hospital assessment in emergency department 1. co-morbidities. Refer all cases for assessment if likely to be a pulmonary problem 1. chest xray report. breathlessness. Consider non-pulmonary causes. immunosuppression. Chest xray changes. coronary artery disease. tachypnoeic. history of work or driving related accident. co-morbidities. immobility. duration and severity of symptoms. old chest xray if available All cases should be referred 1.PAGE 2 NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE DIAGNOSIS BASED Diagnosis Information Required Referral Guidelines Category Obstructive sleep apnoea Snoring. heart failure. results of mantoux. ethnicity. blood test results if available. Refer if: Diagnosis uncertain Poor response to standard therapy Significant co-morbidities and poor social circumstances Persistent xray changes following treatment 2. smoking history. family history. diabetes. Urgent Primary bronchial carcinoma History of smoking and asbestos exposure. Urgent Pulmonary embolism Risk factors. Symptoms and signs including chest pain. Semi-Urgent Consider admission if severe eg. xray report if any. mantoux. Urgent Pneumothorax History of any underlying pulmonary diseases. Urgent/Semi-Urgent Pneumonia Significant symptoms and signs. Tuberculosis Routine Urgent/Semi-Urgent . body mass index. Epworth Sleepiness Score. blood test results if available. “choking episodes” in sleep. Semi-Urgent/Routine Pleural effusion Chest xray report. Urgent/Semi-Urgent Sarcoidosis Any extra pulmonary symptoms or signs. chest xray changes. Refer to hospital emergency medicine department for consideration of admission 1. past history of malignancy. smoking history. alcohol and drug abuse.

fever and night sweats. pleuritic pain. malaise and pleuritic pain. chest xray changes especially apical. history of TB contact and other risk factors. abnormal chest xray. asthma. Smoking related airway disease. Bronchial carcinoma. pneumonia. Breathlessness. Tuberculosis Persistent cough with normal CXR Trigger factors. occupational/environmental exposure. wheezes. chest pain Chronic Respiratory Symptoms Version 1 Respiratory Referral Guidelines and Priorisation Criteria • Date: 24/10/2000 • Authorised: Elective Services. check for general symptoms of infection and thromboembolic risk factors. haemoptysis. signs of pleural effusion/ consolidation. Persistent purulent sputum. Assess quantity and frequency of the haemoptysis. Smoking history. hypotension. spirometry. clubbing. chest xray changes. Progressive exertional dyspnoea. finger clubbing. asbestos exposure. decreasing exercise tolerance. exercise and temperature change. Diffuse parenchymal lung diseases. Pulmonary embolism. stony dullness on percussion. HFA .PAGE 3 R E S P I R AT O R Y M E D I C I N E National Referral Guidelines NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE SYMPTOM BASED Respiratory Systems Evaluation Possible Diagnosis Acute Respiratory Symptoms Consider non pulmonary causes. Haemoptysis Exclude epistaxis and haematemesis. crackles on auscultation. co-existing systemic diseases. weight loss. Smoking history. chronic rhinitis/sinusitis. lymphadenopathy. Check for any accompanying symptoms – dyspnoea. recurrent haemoptysis. tracheal deviation. Bronchial carcinoma. pneumothorax. especially ACE inhibitors and beta blockers. eg dyspnoea. Medications. Chronic obstructive pulmonary disease. bronchiectasis. tuberculosis. reduction of breath sounds. pneumonia. spirometry results. pulmonary infarction. Bronchiectasis Chronic cough. signs of airflow obstruction on examination. chest pain. local or bilateral crackles. spirometry. Pleural effusion. fluid on chest xray. Look for central cyanosis. alveolar haemorrhage. Current or previous smoking. clubbing. episodic fever. systemic symptoms. asthma. shift of apex beat. weight loss. chronic productive cough. pleural rub. gastroesophageal reflux disease. relation to external allergens. haemoptysis. Symptoms of gastroesophageal disease.