Shortness of breath / dyspnoea without a known cause
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.
Asthma
- Acute exacerbation of asthma not responding to therapy
- Asthma with any of the following concerning features:
- coexistent pneumothorax
- pneumonia
- silent chest
- cardiovascular compromise
- altered consciousness
- relative bradycardia
- decreasing rate and depth of breathing
Bronchiectasis / chronic suppurative lung disease (CSLD)
- Bronchiectasis / CSLD with any of the following concerning features:
- altered consciousness
- hypoxia (<90% oxygen saturation) when this is not normal for the patient
- evidence of significant infective exacerbation (fever and/or high-volume purulent sputum)
- new haemoptysis (clots or more than streaks
- new CXR changes indicative of cavitation, consolidation, or pneumonia
Chronic obstructive pulmonary disease (COPD)
- Acute exacerbation not responding to outpatient therapy
- Acute respiratory failure
Cystic fibrosis
- Cystic fibrosis with any of the following concerning features:
- respiratory distress
- new haemoptysis (clots or more than streaks)
- pleural effusion
- consolidation/pneumonia/fever
- non- response to antibiotics for chest infection
Haemoptysis without known lung disease
- Significant haemoptysis defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
- Any haemoptysis with acute dyspnoea, measured hypoxia, altered consciousness, hypotension, tachycardia or chest pain
Interstitial lung disease (ILD)
- Acute exacerbations of known ILD with any of the following concerning features:
- severely breathless/Class 4 dyspnoea (ADL's affected by dyspnoea)
- demonstrated worsening hypoxaemia
- new arrhythmia/chest pain
- Newly diagnosed or suspected ILD with radiographic evidence with Class 4 dyspnoea (ADLs affected by dyspnoea)
Lung cancer
- Suspected or known lung cancer with any of the following concerning features:
- massive haemoptysis
- suspected large airway obstruction
- severe dyspnoea
- SVC obstruction
- hypercalcaemia/hyponatremia with confusion
- symptomatic pleural effusion
Pleural disorders
- Large symptomatic pleural effusion
- Acute pneumothorax
Pulmonary hypertension
- Acute decompensation (hypoxia or right heart failure) with pulmonary hypertension
Sarcoidosis
- Hypercalcaemia with acute kidney injury
Shortness of breath / dyspnoea without a known cause
- Dyspnoea of uncertain origin with any of the following concerning features:
- acute dyspnoea at rest
- demonstrated hypoxia (SpO2 < 90%)
- accompanied by confusion
Tuberculosis / non-tuberculosis mycobacterial infections
- Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
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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)- Class 3-4 dyspnoea
- Oxygen saturation 90-92% at rest
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Category 2
(appointment within 90 calendar days)- Unexplained chronic dyspnoea of uncertain origin
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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 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
- Details and timeline of symptoms including variability and severity
- Relevant medical conditions
- CXR
- Smoking and occupational history if relevant
3. Additional referral information Useful for processing the referral
- FBC, ELFT, ESR, TFT results
- Lung function pre and post bronchodilator
- ECG
- Sputum M/C/S if productive cough
- Other relevant imaging
- Pulse oximetry
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
