Hypertension (General Medicine)
ADULT
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Emergency
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.
Anaemia
- Severe anaemia (Hb <70g/L) with risk of cardiovascular and/or syncopal collapse
- Anaemia associated with definite clinical features of overt gastrointestinal bleeding e.g. haematemesis or melena
- Severe cytopaenias if patient is unwell (i.e. infection, symptomatic anaemia, active bleeding)
- Neutrophils < 0.5x109/L
- Haemoglobin < 70g/L
- Platelets < 20x109/L
Hypertension
- Severe hypertension (systolic BP >180) with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease AND any of the following concerning features:
- confusion
- blurred vision
- retinal haemorrhage
- reduced level of consciousness
- seizures
- proteinuria
- papilloedema
- signs of heart failure
- chest pain
- headache
- If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible
- If hypertension service available refer to hypertension service.
Complex or undifferentiated medical problems
- 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
Complex paediatric patients transitioning to adult services
- Any sudden decompensation in clinical condition that carries risk of serious adverse events or death
Falls
- Any fall occasioning serious trauma (including fractures, major soft tissue injury, head strike or concussion) that cannot be managed in primary care
- Frequent falls (more than one every few days)
Medication review / polypharmacy
- Anaphylactic or other serious adverse drug event
- Markedly prolonged heart rate adjusted QT interval which may herald pro-arrhythmic event
- Marked drug induced electrolyte abnormality (Na <120, K <3.0 or >6.0, corrected Ca >3.0, Mg <0.4)
Osteoarthritis, gout and joint pain
- Acute non-traumatic monoarthritis causing severe pain and/or incapacitating loss of function and/or marked constitutional symptoms
- Suspected septic arthritis
States of altered neurological function
- Witnessed tonic-clonic (grand mal) seizures
- Suspected transient ischaemic attack or stroke based on focal neurological deficits
- Delirium or acute confusional state
- Severe headache or altered level of consciousness of sudden onset
Syncope / pre-syncope
- Syncope / pre-syncope with any of the following concerning features
- exertional onset
- chest pain
- persistent symptomatic hypotension (systolic BP < 90mmHg)
- severe persistent headache
- focal neurological deficits
- preceded by palpitations
- associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
- family history of sudden cardiac death
Unintentional weight loss
- Uncontrolled hyperthyroidism with risk of thyroid storm
- Vomiting, dysphagia or odynophagia suggesting oesophageal or gastric outlet obstruction
- Associated severe electrolyte abnormalities (K+ <3.0 mmol/L, corrected Ca+ <1.6 or >3.0 mmol/L, Mg+ <0.4 mmol/L, PO4- <0.4mmol/L)
Wounds of uncertain cause or non-healing ulcers
- 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 symptoms (SIRS) 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
Chronic Deep vein thrombosis (DVT)
- Patient severely symptomatic e.g., severe swelling or pain.
- Pregnant or given birth within the past 6 weeks
- Present, or suspected, acute iliofemoral or supra-inguinal deep vein thrombosis
- Present or suspected acute laxiliary or subclavian vein thrombosis
Other
- Any condition defined by other CPCs as requiring referral to emergency
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Other useful information for referring practitioners Not and exhaustive list
Minimum Referral Criteria
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Category 1
(appointment within 30 calendar days)- Severe hypertension (>180/110 but below 220/140) in patients over age 50 years with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease and without any of the following concerning features:
- Headache
- Confusion
- Blurred vision
- Retinal haemorrhage
- Reduced level of consciousness
- Seizures
- Proteinuria
- Papilloedema
- Signs of heart failure
- Chest Pain
- If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.
- Severe hypertension (>180/110 but below 220/140) in patients over age 50 years with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease and without any of the following concerning features:
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Category 2
(appointment within 90 calendar days)- Refractory hypertension (>140/90 but below 180/110) in patients over age 50 years and receiving 3 or more antihypertensive agents
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Category 3
(appointment within 365 calendar days)- Patients over 50yrs age with hypertension not reaching target BP levels despite 2 antihypertensive agents
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
2. Essential referral information Referral will be returned without this
- Presence of comorbid conditions such as diabetes or vascular disease
- List of medications including details of all treatments offered and efficacy
- History of BP measurements including 24-hour measurements or home measurements if available
- FBC, ELFT, eGFR, ECG, CXR results
- Urine albumin creatinine ratio (ACR) or urine protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable)
- Urinalysis
3. Additional referral information Useful for processing the referral
- History of smoking, alcohol intake and drug use (including recreational drugs)
- Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
- Any investigations relevant to co-morbidities
4. Request
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General referral information
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.)
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Notes
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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.
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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.
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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.
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Last updated: 13 June 2023
