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.
Anaemia
- Severe anaemia (Hb <70g/L) with risk of cardiovascular and/or syncopal collapse
- Anaemia associated with definite clinical features of overt gastrointestinal bleeding e.g. haematemesis or melena
- Severe cytopaenias if patient is unwell (i.e. infection, symptomatic anaemia, active bleeding)
- Neutrophils < 0.5x109/L
- Haemoglobin < 70g/L
- Platelets < 20x109/L
Hypertension
- Severe hypertension (systolic BP >180) with no known ischaemic heart disease, cardiomyopathy, or chronic kidney disease AND any of the following concerning features:
- confusion
- blurred vision
- retinal haemorrhage
- reduced level of consciousness
- seizures
- proteinuria
- papilloedema
- signs of heart failure
- chest pain
- headache
- If suspected gestational hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible
- If hypertension service available refer to hypertension service.
Complex or undifferentiated medical problems
- Any sudden decompensation in clinical condition that carries risk of serious adverse events or death
- Pyrexia of unknown origin with temp ≥ 39ºC
- Pyrexia with neutropaenia
- Delirium
- Suspected systemic vasculitis associated with symptoms, signs or investigation results suggestive of vital organ involvement
- Suspected temporal arteritis (giant cell arteritis) with markedly elevated ESR (>100) and/or jaw claudication and/or visual disturbance
Complex paediatric patients transitioning to adult services
- Any sudden decompensation in clinical condition that carries risk of serious adverse events or death
Falls
- Any fall occasioning serious trauma (including fractures, major soft tissue injury, head strike or concussion) that cannot be managed in primary care
- Frequent falls (more than one every few days)
Medication review / polypharmacy
- Anaphylactic or other serious adverse drug event
- Markedly prolonged heart rate adjusted QT interval which may herald pro-arrhythmic event
- Marked drug induced electrolyte abnormality (Na <120, K <3.0 or >6.0, corrected Ca >3.0, Mg <0.4)
Osteoarthritis, gout and joint pain
- Acute non-traumatic monoarthritis causing severe pain and/or incapacitating loss of function and/or marked constitutional symptoms
- Suspected septic arthritis
States of altered neurological function
- Witnessed tonic-clonic (grand mal) seizures
- Suspected transient ischaemic attack or stroke based on focal neurological deficits
- Delirium or acute confusional state
- Severe headache or altered level of consciousness of sudden onset
Syncope / pre-syncope
- Syncope / pre-syncope with any of the following concerning features
- exertional onset
- chest pain
- persistent symptomatic hypotension (systolic BP < 90mmHg)
- severe persistent headache
- focal neurological deficits
- preceded by palpitations
- associated significant physical injury (e.g. fractures, extreme soft tissue trauma, intracranial bleeds) or causing motor vehicle accident
- family history of sudden cardiac death
Unintentional weight loss
- Uncontrolled hyperthyroidism with risk of thyroid storm
- Vomiting, dysphagia or odynophagia suggesting oesophageal or gastric outlet obstruction
- Associated severe electrolyte abnormalities (K+ <3.0 mmol/L, corrected Ca+ <1.6 or >3.0 mmol/L, Mg+ <0.4 mmol/L, PO4- <0.4mmol/L)
Wounds of uncertain cause or non-healing ulcers
- Severe cellulitis with ongoing or worsening systemic symptoms or fevers despite oral antibiotics for 48 hours
- Foot ulcer in diabetic patient that is not responding to oral antibiotics and regular wound cleaning
- Any infected ulcer associated with systemic inflammatory response symptoms (SIRS) or excessive pain or features suggestive of abscess formation, osteomyelitis or deep tissue infection (necrotising fasciitis)
- Acute Charcot arthropathy
- Ulcers or wounds in a limb with markedly compromised circulation
Chronic Deep vein thrombosis (DVT)
- Patient severely symptomatic e.g., severe swelling or pain.
- Pregnant or given birth within the past 6 weeks
- Present, or suspected, acute iliofemoral or supra-inguinal deep vein thrombosis
- Present or suspected acute laxiliary or subclavian vein thrombosis
Other
- Any condition defined by other CPCs as requiring referral to emergency