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Post-operative wound/dehiscence

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Wounds of traumatic aetiology

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Wounds with complex foreign body involvement and significant damage to associated surrounding structures including blood vessels, nerves, muscles, joints and tendons. 
  • Wounds with associated compound fractures
  • Persistent significant bleeding not controlled with usual measures 
  • Worsening pain and/or pain not in keeping with mechanism of injury
  • Initial acute burns should be managed as per ANZBA guidelines
  • Refer to Vascular High Risk Foot CPC or Diabetic High Risk Foot CPC 

Arterial/ischaemic ulcer

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Worsening pain and/or pain not in keeping with progression of the wound/ulcer
  • Sepsis or acutely unwell due to infection3
  • Acute or critical limb ischaemia with necrosis
  • Rapidly deteriorating ulceration or necrosis.3
  • Ulcers or wounds in a limb with markedly compromised circulation

Wounds on the High-Risk Foot

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Worsening pain and/or pain not in keeping with progression of the wound/ulcer
  • Progressive cellulitis despite initial treatment
  • Acute or critical limb ischaemia with necrosis
  • Acute Charcot arthropathy if access to podiatry is not accessible within 48 hours

Stoma related wounds

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Worsening pain and/or pain not in keeping with progression of the wound
  • Progressive cellulitis despite initial treatment
  • Suspected incarcerated hernia or underlying abscess
  • Suspected bowel obstruction resulting in non-functioning stoma
  • Persistent significant bleeding not controlled with usual measures 
  • Stomal change in colour from red / pink to blue or black
  • Stomal prolapse causing circulatory compromise
  • Bleeding peristomal varices
  • Ongoing high output stoma and signs of dehydration

NB: If the problem is with the stomal appliance the patient can self-refer to stomal therapy nurse.  Patients not in contact with regular stomal therapy nurse/service can be referred by GP.

Pressure injury

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Worsening pain and/or pain not in keeping with progression of the wound/ulcer
  • Pressure injury if causing systemic infection
  • Patients with spinal injuries should be referred to Spinal Outreach Team (SPOT)

Post-operative wound/dehiscence

  • Systemic inflammatory response symptoms (SIRS) or clinically unwell
  • Worsening pain and/or pain not in keeping with progression of the wound/ulcer
  • Prosthesis / metal work is on view
  • Purulent discharge with associated fevers
  • Refer to local Healthpathways or local guidelines

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Non healing wound of more than 6 weeks duration
    • History of hernia repair with mesh on view
    • Immunocompromised patients
    • Acute wound dehiscence in the post op period
  • Category 2
    (appointment within 90 calendar days)
    • No category 2 criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Co-morbidities and past medical history 
  • Relevant surgical history (date of surgery/place of surgery)
  • Details of all treatments offered, and efficacy to date e.g. type of dressings used, date of commencement of any antibiotics with dose prescribed.
  • If patient is still under the care of surgical team, advise next follow up appointment. 

3. Additional referral information Useful for processing the referral

  • History of allergies and list of current medications
  • Wound history e.g. duration, description and size, wound initiating event.
  • Relevant pathology (as clinically indicated)
  • Relevant medical imaging results if available –i.e. x-ray, ultrasound 
  • Clinical photograph – with patient’s consent, where secure image transfer, identification and storage is possible

4. Request

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.)
  • 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.

  • 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.

  • 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.