REFERRAL GUIDELINES: GENERAL SURGERY - Alfred Health
Outpatient Referral Guidelines
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REFERRAL GUIDELINES: GENERAL SURGERY
Essential Referral Content
Exclusion Criteria
Demographic
Date of birth Contact details (including mobile phone) Referring GP details Interpreter requirements Medicare number
Clinical
Reason for referral Duration of symptoms Relevant pathology & imaging reports Past medical history Current medications
The Alfred Outpatient Referral Form is available to print and fax to the
Outpatient Department on 9076 6938
The following conditions are not routinely seen at the Alfred:
Patients who are being treated for the same condition at another Victorian public hospital
Children under 18 years of age are not seen at The Alfred
Cosmetic breast surgery is not offered at The Alfred - see: "Guidelines for Aesthetic Surgery on the Public Hospital Waiting List"
REFERRAL PROCESS: GENERAL SURGERY
STEP 1
STEP 2
STEP 3
You will be notified when your referral is received by outpatients.
Essential referral content will be checked and you may be contacted if further information is required.
The referral is triaged by the specialist unit according to clinical urgency.
This determines how long the patient will wait for an appointment.
Patients with urgent conditions are scheduled to be seen within 30 days. Patients with routine conditions are given the next available appointment according to clinical need.
Both the referrer and patient are notified.
Some clinics offer an MBS-billed service. There is no out of pocket expense to the patient. MBS-billed services require a current referral to a named specialist? please provide your patient with a 12 month referral addressed to the specialist of your choice. Further information regarding the specialists attending the General Surgery clinics are available here: Breast Endocrine & General Surgery, Colorectal Surgery, HepatoPancreatoBiliary Surgery & Oesophago-Gastric & Bariatric Surgery. Please note that your patient may be seen by another specialist in that clinic, in order to expedite their treatment.
Please note: The times to assessment may vary depending on size and staffing of the hospital department.
If you are concerned about the delay of the outpatient appointment or if there is any deterioration in the patient's condition, please contact the Surgical Registrar on call on 9076 2000.
The Alfred gratefully acknowledges the assistance of the Canterbury and District Health Board in New Zealand in developing these guidelines. They are intended as a guide only and have been developed in conjunction with the Heads of Unit of The Alfred.
Date Issued: March 2006 Last Reviewed: September 2018
Outpatient Referral Guidelines
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REFERRAL PRIORITY: GENERAL SURGERY
The clinical information provided in your referral will determine the triage category. The triage category will affect the timeframe in which the patient is offered an appointment.
IMMEDIATE
Direct to the Emergency & Trauma Centre
URGENT
Appointment timeframe within 30 days
ROUTINE
Appointment timeframe greater than 30 days
depending on clinical need
Threatened cervical airway obstruction
Incarcerated hernia and/or symptoms of bowel obstruction, local tenderness or erythema.
Diverticulitis with systemic sepsis Large bowel obstruction Severe PR bleeding Perianal abscess Obstructive jaundice Haematemesis Melaena Acute pancreatitis Acute cholecystitis Acute, severe biliary pain
Cachexia Acute dysphagia with intolerance of
fluids Severe abdominal pain or
intolerance of fluids after bariatric surgery
Fever or shortness of breath after bariatric surgery
Diagnosed breast malignancy - will be seen within Lipomas
1 week of referral. Please contact Surgical Registrar on 9076 2000.
Breast screening (unless significant family history and
Diagnosed or suspected upper GI tract
refer to guidelines)
malignancy-- contact Oesophago-Gastric/Bariatric Surgical Registrar or OG Cancer nurse coordinator
Carpal tunnel
(Cate Milnes) via switchboard on 9076 2000.
Gastroesophageal reflux
Diagnosed liver, pancreas, biliary or duodenal
Hiatus hernia without pain or
malignancy--contact the HepatoPancreatoBiliary
dysphagia
Fellow via switchboard on 9076 2000.
Asymptomatic gallstones
Breast lumps
Recurrent cholecystitis
Pigmented skin lesions Head and neck masses Thyroid masses Adrenal masses
Chronic pancreatitis Small gallbladder polyps Asymptomatic common bile
duct stones
Hernias that have required acute reduction Acute painful leg ulcers
Non-suspicious pancreatic cystic lesions
Uncomplicated hernia Benign lumps
Biliary dilatation without stone or mass
Inguinal hernia (for exceptions refer to notes)
Parathyroid disease
Adrenal abnormalities
Confirmed or suspected colorectal cancer
Suspected liver, pancreas, biliary or duodenal malignancy
Dyspepsia and/or dysphagia to solids associated with weight loss and/or anaemia
Known gallstones with ongoing biliary colic
Gall-bladder mass or polyp >10mm
Vomiting and/or severe reflux following bariatric surgery
Phone the Surgical Registrar on call on 9076 2000 and/or send to The Alfred Emergency & Trauma Centre.
Urgent cases must be discussed with the Surgical Registrar on call to obtain appropriate prioritisation and a referral faxed to 9076 6938.
Fax referral to 9076 6938
If you are concerned about the delay of the outpatient appointment or if there is any deterioration in the patient's condition, please contact the Surgical Registrar on call on 9076 2000.
Outpatient Referral Guidelines
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GENERAL SURGERY
Referral Guideline Contents
General referral guidelines
Miscellaneous General Surgery Hernia Skin (See also Plastic Surgery Guidelines) Venous (See Vascular Surgery Guidelines)
Breast, Endocrine & General Surgery (BES) Thyroid masses Parathyroid disease Neck masses - Painless masses - Painful masses Adrenal mass Breast Disease - Family history of breast disease - Breast lump - Breast pain - Nipple discharge - Nipple retraction - Change in skin contour
Guide for investigation of a breast lump
Colorectal and General Surgery (CRS) Diseases of the Colon
Colorectal Cancer: - Confirmed Colorectal Cancer - Suspected Colorectal Cancer Ano-rectal Disease: - Haemorrhoids - Anal fistula - Anal fissure
Oesophago-Gastric & Bariatric Surgery (OGB) Disorders of the oesophagus
- Dysphagia - Reflux symptoms Disorders of the stomach and duodenum Bariatric surgery
HepatoPancreatoBiliary Surgery (HPB) Symptomatic disorders of the pancreas, biliary tree and liver Gallbladder pain
Biliary colic Cholecystitis Pancreatic/common bile duct pain Pancreatitis Obstructive jaundice Cholangitis Pancreatic cancer
Outpatient Referral Guidelines
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GENERAL REFERRAL GUIDELINES
Evaluation
Management
Referral Guidelines
Problems are categorised under the following groupings, and managed by the corresponding service:
BREAST, ENDOCRINE AND GENERAL SURGERY UNIT (BES):
Neck masses Thyroid masses Adrenal masses Parathyroid disease Breast disease
COLORECTAL AND GENERAL SURGERY UNIT (CRS):
Inflammatory bowel disease Diseases of the colon Anorectal disease
A through history and examination is required to determine a specific diagnosis and its degree of urgency. Some appropriate investigation by the referrer will facilitate the referral process.
Most general surgical diagnoses require referral to specialist management. However, these guidelines are provided to give greater clarity in situations of the primary/secondary interface of care. Clearly telephone/fax communication would enhance appropriate treatment.
If you are concerned about the delay of the outpatient appointment or if there is any deterioration in the patient's condition, please contact the General Surgery registrar on call on 9076 2000.
OESOPHAGO-GASTRIC AND BARIATRIC SURGERY UNIT (OGB):
Disorders of the oesophagus Disorders of the stomach and
duodenum Bariatric surgery
HEPATOPANCREATOBILIARY SURGERY UNIT (HPB):
Disorders of the pancreas Disorders of the biliary tree & liver
MISCELLANEOUS GENERAL SURGERY
Hernia Skin Venous
Outpatient Referral Guidelines
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Miscellaneous General Surgery
HERNIA
Evaluation
Incisional hernia Femoral hernia Inguinal hernia Umbilical hernia
Management
Pain in groin sometimes precedes lump. Pain may be colicky and associated with vomiting (intestinal obstruction)
Lump in groin - may be intermittent / reducible but is usually most obvious when patient is standing
Diagnostic studies may include Ultrasound (only required if hernia can not be felt on examination.) The Alfred Radiology request form
Referral Guidelines
Refer for IMMEDIATE admission via The Alfred Emergency & Trauma Centre if incarcerated and symptoms of bowel obstruction, local tenderness or erythema.
If uncomplicated, refer to any General Surgery clinic - urgent or routine according to clinical indication.
SKIN
Evaluation
Ganglia Lipomas Sebaceous cysts Minor skin lesions
VENOUS
Evaluation
Management
USS of lesion +/- CT scan if malignancy suspected
Include details of functional impairment in referral.
Referral Guidelines
Refer urgently if malignancy suspected, otherwise routine, depending on functional difficulties.
Management
Referral Guidelines
Refer to Vascular Surgery Guidelines:
Vascular Surgery Referral and Management Guidelines
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