Paediatric Persistent pain
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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.
Adult persistent pain
- Patients with acute pain (and no provisional diagnosis)
- Patients with acute pain and new neurological symptoms e.g. Cauda Equina Syndrome (CES)
- Patients requiring acute mental health services
- Concerns pertinent to any medical/surgical condition which raise the possibility of serious underlying disease (malignancy or infection) should be reviewed by the appropriate specialty either via emergency department or high priority outpatient appointment
Paediatric persistent pain
- Concerns pertinent to any medical/surgical condition which raise the possibility of harm occurring to the body due to serious underlying disease (e.g. inflammatory condition, infection or malignancy) should be reviewed by the appropriate specialty either via emergency department or high priority outpatient appointment
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| Category 1 (appointment within 30 calendar days) |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
Please note that in the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment |
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 not otherwise accessible to the patient
- For advice regarding management
- To engage in an ongoing shared care approach between primary and secondary care
- Reassurance for GP/second opinion
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
2. Essential referral information Referral will be returned without this
- Pain history:
- date of injury/onset of pain
- likely proposed cause of pain or mechanism of injury
- location and nature of pain
- history of treatment for pain
- Family history of pain
- Physical examination findings
- Provisional diagnosis (if available) or underlying mechanisms
- Assessments by other PPMS providers and/or other relevant specialist services including Allied Health (if available)
- Current treatment from or referral to other specialist services for the same pain problem
- Medications including past analgesia/medication trialled for pain condition
- History of opioids/drugs of dependence for more than eight weeks
- Neurodevelopmental differences
- Mental health history including trauma history or adverse childhood experiences
- Current psychosocial stressors, engagement with mental health services
- Functional status including details about school attendance and participation, sleep and sleep hygiene and physical activity (incidental and organised)
- Details about participation in age-appropriate ADLs, and trajectory of this engagement throughout childhood
- Living circumstances including details about complex family demographics and any custody arrangements, child safety involvement or legal processes where relevant
- Investigations including pathology and imaging depending on the reason for referral (if available)
- Confirmation of OOHC (where appropriate)
3. Additional referral information Useful for processing the referral
- Family genogram
4. Request
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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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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: 6 June 2024
© State of Queensland (Queensland Health) 2023
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