Direct to an emergency department for:
Chronic obstructive pulmonary disease (COPD) with
- significant, new or changed respiratory symptoms (for example unable to eat, sleep or walk)
- breathlessness at rest and oxygen saturation < 90 percent, or a reduction of 3 to 4 percent from usual baseline
- sudden or severe worsening of symptoms (e.g. breathlessness, cough)
- acute confusion or impaired consciousness.
Criteria for referral to public hospital service
- Assessment for difficult to control symptoms or unusual symptoms such as haemoptysis or dysfunctional breathing, where lung cancer or other critical respiratory illness has been excluded
- Assessment for uncertain diagnosis
- bullous lung disease
- COPD patient age < 40
- onset of right-sided heart failure
- exclusion of asthma
- frequent chest infections
- Advice on, or review of, the management of moderate or severe COPD or COPD with rapid decline in forced expiratory volume
- Assessment for lung volume reduction surgery.
Information to be included in the referral
Information that must be provided
- Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from the referral to the health service
- Onset, nature and duration of symptoms and breathlessness
- How these symptoms are impacting on activities of daily living including impact on work, study, school or carer role
- Findings on physical examination, including oxygen saturation
- Smoking history (cigarettes and all forms of tobacco, nicotine, vaping and cannabis)
- At risk occupational history if relevant
- Past medical history and comorbidities
- Details of previous medical management including the course of treatment and outcome of treatment
- Current and complete medication history (including non-prescription medicines, herbs and supplements)
- History of any other inhalant use, including if the patient is still using
- Chest x-ray(including date and details of the diagnostic imaging practice)
- Recent (in previous 6 months) full blood examination (FBE) results
- Recent (in previous 6 months) urea and electrolyte results.
Provide if available
- Spirometry
- Height
- Weight
- Sputum culture results
- Electrocardiogram (ECG) tracings
- Echocardiogram report (including date and details of the diagnostic imaging practice)
- Chest CT scan (including date and details of the diagnostic imaging practice)
- Current vaccination status
- If the person has a limited life expectancy
- Details of any Advance Care Directive
- If the person identifies as an Aboriginal and Torres Strait Islander.
Additional comments
The Summary and referral information lists the information that should be included in a referral request.
The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.
Referrals for unexplained chronic breathlessness should be directed to a respiratory service provided by the health service.
Referrals for assessment for lung transplant must be directed to respiratory services at Alfred Health.
Referrals for pulmonary rehabilitation should be directed to a pulmonary rehabilitation service.
Request for domiciliary oxygen should be directed to the Victorian Statewide Equipment Program (SWEP). To be eligible for subsidised oxygen through the Domiciliary Oxygen Program, the applicant’s clinical test results must meet the Thoracic Society of Australia and New Zealand (TSANZ) guidelines for domiciliary oxygen provision. Domiciliary oxygen is not available for occasional use, or for use with nebulisers, suctioning equipment or for occasional exacerbations of asthma. Domiciliary oxygen will not be supplied to anyone who is a current smoker or who has resumed active smoking once approved for domiciliary oxygen.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
Patients that are stable, or not for further active management.