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
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