GPLink Update from the GPs at Royal North Shore
Issue 8 January 2025
In this edition we provide an update from our new GPLO, Dr Caroline Guirgis. We also given an important update about the switch to eReferrals, information on the hysteroscopy clinic, an update on the respiratory clinic criteria and information on videos to help parents navigate the first 2000 days of their child’s life. We also provide an invitation to our GP and ED networking and education event. New GPLO at RNSH
Hello, my name is Dr Caroline Guirgis, and I am a new GP Liaison Officer (GPLO) at Royal North Shore Hospital, along with Dr David Cosgriff. I would like to introduce myself and tell you how excited I am to occupy this role; the only GPLO position within the NSW Health system. I have been in this position in a temporary capacity since April this year and continue to be astounded by the real difference this bi-directional collaboration can make. I have been a GP for 10 years and am passionate about integrated care. My other roles include being a clinical editor for HealthPathways as well as Co-chair of the NSW Health Agency for Clinical Innovation (ACI) GP Advisory Group, providing expert advice to NSW Health from a GP perspective. My aim is to improve the interface between community and hospital care, to therefore improve patient outcomes in our area. Please feel free to contact me or David if you need any assistance in navigating the ambulatory care department, have any questions about our role or need assistance in advocating for your patients. Our email address is NSLHD-GPLO@health.nsw.gov.au I look forward to meeting some of you at our ED/GP Networking event in February!
Dr David Cosgriff and Dr Caroline Guirgis
Electronic referrals (eReferrals) - Mandatory from June 2025
What Actions Are Required? For HealthLink Users: If you use practice software as below that interfaces with HealthLink, you already automatically have access to eReferrals for all outpatient clinics. Video guides are available to help you get started: Electronic Referrals for Outpatient Clinics-Northern Sydney Local Health District Compatible practice software:
From June 2025, Northern Sydney Local Health District (NSLHD) will transition to accepting only Electronic Referrals (eReferrals) for outpatient services, replacing all paper-based methods such as fax or email or post. The change applies to outpatient clinics and community health services at Royal North Shore, Hornsby Ku-ring- gai, Mona Vale and Ryde hospitals. What are eReferrals? eReferrals are electronic forms submitted by GPs/ referrers via Healthlink through GP practice software (full list of compatible software below) or MyHealthLink portal. These forms streamline the referral process, making it faster, more secure and efficient for healthcare providers and patients alike. Benefits of eReferrals Using eReferrals offers numerous advantages for referrers: 1. Seamless Integration: eReferrals are integrated with practice software and can be launched directly. 2. Pre-populated Information: Multiple fields are automatically populated including patient details. 3. Easy Attachment of Clinical Information: Relevant clinical documents can be easily attached. 4. Speed and Security: eReferrals are sent instantly and securely. 5. Patient Record Management: Completed eReferrals are saved against the patient’s record in your practice software. 6. Real-Time Notifications: Referrers receive secure notification on referral receipt, outcome, and triage status. 7. Enhanced Service Visibility: Referrers can select from a list of outpatient services and clinicians, improving accessibility.
For Non-HealthLink Users: Referrers without HealthLink compatible practice software can use the MyHealthLink portal to access eReferrals. Note: a HealthLink account is required. Access the MyHealthLink portal.
How can I get help with this? For guidance on submitting and updating eReferrals, please refer to the HealthLink Smartform user guides. If you have further questions or require support, please contact: eReferral Project Team at NSLHD-eReferral@health.nsw.gov.au or 02 94631253
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GPLink | January 2025
Office (Awake) Hysteroscopy: Do We Really Need General Anaesthesia?
Since its introduction in 1869, hysteroscopy has become the gold standard for managing intrauterine pathology, making it the most common gynaecological surgery in Australia[1]. Traditionally, this procedure requires general anaesthesia (GA) due to its invasive and painful nature. However, advancements in medical technology and new surgical techniques now allow for hysteroscopy to be performed safely in an outpatient setting, enabling patients to remain awake and alert with minimal discomfort. This procedure is offered at Royal North Shore Hospital. Advantages of Office Hysteroscopy Over Traditional Hysteroscopy The primary benefit of office hysteroscopy (OH) is the avoidance of GA. While the risks associated with GA are rare, they can include aspiration, respiratory complications, allergic reactions, and damage to the throat or mouth. Recovery from GA typically takes 2-3 days, with potential for drowsiness, nausea, and cognitive deficits. In contrast, the risks of OH are minimal, with the main complication being vasovagal syncope from cervical stimulation. The chance of uterine perforation and cervical trauma is significantly reduced since patients can communicate when significant pain is experienced[2],[3]. Non-medical considerations favouring OH include avoiding extended time off work, carer’s leave, and driving restrictions, making it particularly advantageous for those balancing work, studies, or family commitments. Financially, OH benefits both the patient and the Australian healthcare system, eliminating day surgery admissions and anaesthetist fees[4]. The success rate of OH exceeds 95 per cent with equivalent accuracy of results. It maintains high levels of patient satisfaction, with 95 per centof women preferring to undergo OH again and 97 per cent recommending it to others4,[5]. The Patient Experience Performed in a comfortable office environment, OH reduces the anxiety often associated with surgery and hospital visits. Local anaesthetic is occasionally used if needed, but always without sedation, allowing patients to remain in control during the 15-30 minute procedure. OH is interactive; patients can choose to watch and engage in real-time discussions about their diagnosis and treatment. While mild cramps may occur, the
procedure is well-tolerated. The average pain score is just three out of 10. Indications and Suitability for Office Hysteroscopy All routine indications for hysteroscopy still apply: abnormal bleeding (heavy or irregular periods, post- menopausal bleeding), intra-uterine pathology identified via ultrasound, and fertility concerns (miscarriages, unexplained infertility). Few patients are unsuitable for OH. The development of narrow diameter hysteroscopes eliminates the need for speculums and cervical dilators, broadening access for all patients, regardless of age, nulliparity, virginity, menopause, or BMI. The use of hysteroscopic shavers means we are also not limited by number, size or type of intra-uterine pathology. However, cervical stenosis may increase failure rates, and patients with cardiovascular issues should have resuscitation equipment on standby due to the risk of cervical shock. Ultimately, patient preference is key; the only truly unsuitable candidate is one who opts for GA. Office hysteroscopy is already the standard of care in countries like the UK and USA. Australia has been slower to adopt these techniques, but Australian women have indicated their preference as they seek greater control and involvement in their healthcare decisions. Referral Pathways A pelvic ultrasound is beneficial and can aid in counselling, but it is not mandatory. Patients can be referred directly to the outpatient hysteroscopy clinic at Royal North Shore Hospital through Women’s Health Ambulatory Care. [1] Marlow JL. Media and delivery systems. Obstet Gynecol Clin North Am. 1995 Sep;22(3):409-22. [2] Bennett A, Lepage C, Thavorn K, et al. Effectiveness of outpatient versus operating room hysteroscopy for the diagnosis and treatment of uterine conditions: a systematic review and meta-analysis. J Obstet Gynaecol Can 2019;41:930–41 [3] Luerti M, Vitagliano A, Di Spiezio Sardo A, Angioni S, Garuti G, De Angelis C. Effectiveness of hysteroscopic techniques for endometrial polyp removal: The Italian Multicenter Trial. Italian School of Minimally Invasive Gynecological Surgery Hysteroscopists Group. J Minim Invasive Gynecol 2019;26:1169–76 [4] Nanayakkara P, Xiao J, Aref-Adib M, Ades A. Increasing the adoption of ambulatory hysteroscopy in Australia–cost Comparisons and patient satisfaction. J Obstet Gynaecol 2021; 1-5:509–513 [5] Kremer C, Duffy S, Moroney M. Patient satisfaction with outpatient hysteroscopy versus day case hysteroscopy: randomised controlled trial. BMJ 2000;320:279–82
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GPLink | January 2025
Updated Respiratory Clinic Referral Criteria The Respiratory Clinic at Royal North Shore Hospital has updated its referral criteria. We have included these criteria below. They are also available on healthpathways (user name healthpathways password gateway). Referral Criteria The following conditions should be immediately referred to the Emergency Department: • Acute exacerbation of COPD with respiratory failure • Acute severe asthma • Significant pleural effusion
• Interstitial Lung Disease-CT scan evidence of interstitial lung disease. • Incidental Pulmonary • nodules • Solid lung nodule or mass >8mm*-Semi-solid nodule>6mm* (present for >3 months) or ground glass nodule>6mm* (present for at least 6 months) * Dimension based on average of long and short axes * Smaller nodules can be re- evaluated as per Fleischner Guidelines. * High risk features include-heavy smoking history, exposure to asbestos, radon or uranium, FHx lung cancer, older age, gender (F>M), race (black>white) upper lobe, spiculation, <5 nodules, coexistent emphysema and • pulmonary fibrosis. If uncertain, follow high risk recommendation. • Suspected Lung Cancer-Lung mass suggestive of malignancy Investigations required for referral: Chest CT scan with IV contrast, not high resolution; recent blood results (FBC, U+E, LFT, LDH, Calcium, Magnesium, Phosphate, coagulation profile, random glucose) Refer urgently Patients with known lung cancer (biopsy proven) should be referred to the Northern Sydney Cancer Centre
• Pulmonary embolism • Severe breathlessness • Large volume haemoptysis • Pneumothorax
• Severe Community Acquired Pneumonia • Presenting Complaint When to Refer • Asthma-Difficult control despite primary care asthma diagnosis and therapy (preventer prescribed). - Diagnostic uncertainty. • Bronchiectasis/COPD-Moderate to severe disease with symptoms or frequent exacerbations (>3/year).
GP and ED Networking Event You are invited to join us for a GP and ED Networking event on Wednesday, February 19th at 7pm in the Kolling Building at Royal North Shore Hospital. We will be holding a discussion panel with emergency department (ED) representatives from Royal North Shore Hospital, as well as representatives from Virtual Hospital and Hospital in the Home. There will be a presentation from the emergency department team on “Current Approach to Acute Stroke Investigation and Treatment in the ED”. Get to know each other and participate in a panel discussion to improve collaboration and troubleshoot common communication issues.
Please RSVP NSLHD-GPLO@health.nsw.gov.au by Wednesday 12th of February
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GPLink | January 2025
Supporting kids to have the best start in life
The videos cover the following topics: • Physical Development • Fine & gross motor skills • Fundamental Movement Skills • 24 hour movement guidelines (Including screen time and sleep recommendations) • Healthy food and drink • Developmental milestones • Oral Health In addition to the videos supporting parents and carers, the Small Bites for Big Steps videos are also being used by early childhood educators and Family Day Care across NSW. Showcases are available to support each sector enhance children’s development in areas such as tummy time, eye tracking, sleep and settling for babies, the vestibular system, water consumption and fuss-free mealtimes for toddlers and school readiness and self-regulation for preschoolers.
If you have parents with children in their first 2000 days (aged 0-5years), and they are asking about child development milestones and healthy habits, refer them to Northern Sydney Local Health District’s ‘Small Bites for Big Steps’ video series. The videos present practical ideas from early childhood nurses and children’s allied health professionals to support children have the best start to life. “Children’s development in the first 2000 days of life is significant and can be overwhelming. 90% of a child’s brain develops by age 5, so engaging children in play and activities to enhance development is crucial during
this time period” explained Population Health Promotion’s Early Years Manager, Nicole Tate.
“The Small Bites for Big Steps videos in the Families and Carers showcases are broken down into age ranges; 0 to 18 months, 18months to 3 years and 3 to 5 years. Practical bite-sized pieces of information, appropriate for each age group, on health and wellbeing are presented.”
Visit nshp.com.au/SmallBitesForBigSteps for more information and watch the videos. If your practice is interested in promoting the videos to patients (including accessing the videos for display on practice screens) email the team at nslhd-smallbitesforbigsteps@health.nsw.gov.au
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GPLink | January 2025
NSLHD Virtual Palliative Care Navigator Service GPs do you need support or advice navigating or accessing appropriate palliative care or symptom management for your patients?
Eligibility: The Virtual Palliative Care Navigator Service helpline is open to GPs, medical specialists, and other community healthcare providers. Referrals: • Contact a Virtual Palliative Care Navigator Clinical Nurse Consultant on 0429 894 357 to discuss. • The Virtual Palliative Care Navigator Service operates between 9am-5pm Monday to Friday . Feedback We aim to improve communication between the hospital and primary care; improve patient experience of outpatients and ensure patients arrive back at their GP with adequate information to plan their ongoing care. We welcome your feedback on this information about the clinics at Royal North Shore. Please let us know if the format or content can be adjusted to better communicate the services available at the hospital. Email NSLHD-GPLO@health.nsw.gov.au
The NSLHD Virtual Palliative Care Navigator Service provides virtual access to a palliative care clinical nurse consultant between 9am and 5pm Monday to Friday via a helpline. The service offers consultation and care navigation regarding supportive and palliative care services across NSLHD for patients and carers. The Virtual Palliative Care Navigator Service can: • Navigate palliative care pathways between community services and acute settings • Support GPs regarding acute issues in supportive and palliative care for patients in the community • Enhance access to supportive and palliative care advice and referrals to reduce unnecessary ED presentations and acute hospital admissions • Connect community-based palliative care management to ensure the right care in the right place.
Feedback
We aim to improve communication between the hospital and primary care; improve patient experience of outpatients and ensure patients arrive back at their GP with adequate information to plan their ongoing care. We welcome your feedback on this information about the clinics at Royal North Shore. Please let us know if the format or content can be adjusted to better communicate the services available at the hospital. Email: NSLHD-GPLO@health.nsw.gov.au
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GPLink | January 2025
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