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R E S P I R AT O R Y M E D I C I N E
National Referral Guidelines
Category Definitions : These are recommended guidelines for health professionals referring patients for assessments/treatment in a HHS.
1. Urgent

- seen immediately or within 1 to 2 weeks

2. Semi - Urgent

- within 2 to 6 weeks

3. Routine

- within 2 to 12 weeks

Immediate and Urgent cases must be discussed with the Specialist or Registrar in order to get appropriate prioritisation and then a referral
letter sent with the patient, faxed or e-mailed. The times to assessment may vary depending on size and staffing of the hospital department.

Note : These guidelines are provided as both symptom and diagnosis based. Where the diagnosis
is not known then the symptom based referral guidelines should be used.

NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE DIAGNOSIS BASED

Diagnosis
Asthma

Information Required

Referral Guidelines

Category

Severity of symptoms, previous

hospitalisation (particularly ICU
admission), oral Prednisone use,
current medications,
occupation.

Admission for acute severe

asthma not responding to GP
treatment, asthma with intercurrent disease (eg
pneumonia).

1.

Urgent

3.

Routine

Recurrent symptoms
despite standard
treatment

2.

Semi-Urgent

Features of severe asthma,

eg nocturnal wakening,
frequent courses of
Prednisone, frequent
severe attacks requiring
hospital admission or
recent life-threatening
attack

1.

Urgent/Semi-Urgent

Refer to OP Clinic if:

Diagnosis uncertain
Need for hospital based
lung function testing or
asthma education

Bronchiectasis

Chest xray report. Past history

of childhood infections. History
of recurrent chest infections,
haemoptysis. Blood and sputum
test and spirometry results if
available.

All patients with suspected

bronchiectasis should be
referred for baseline
assessment

2.

Semi-Urgent/Routine

COPD

Assessment of severity, degree

of breathlessness, signs and
symptoms of right heart failure,
comorbidity, spirometry, chest
xray, nutritional state,
medications, oximetry.

Admission for acute

exacerbations with
respiratory failure

1.

Urgent

Outpatient assessment for

3.

Routine

Severity of symptoms, chest xray

report, lung function and blood
tests if available.

Refer all cases for assessment

and management

1.

Urgent/Semi-Urgent

Diffuse parenchymal lung

diseases (DPLD) eg
interstitial lung disease

Optimising management
Pulmonary function testing
Nutritional advice
Physiotherapy assessment
Rehabilitation
Oxygen therapy assesment

Version 1 Respiratory Referral Guidelines and Priorisation Criteria Date: 24/10/2000 Authorised: Elective Services, HFA

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NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE DIAGNOSIS BASED

Diagnosis

Information Required

Referral Guidelines

Category

Obstructive sleep apnoea

Snoring, choking episodes

in sleep, body mass index,
Epworth Sleepiness Score,
history of work or driving
related accident, tobacco and
alcohol use, co-morbidities,
eg hypertension, heart
diseases.

Treat insomnia and upper

airway problems if
appropriate. Advise on weight
loss. Refer for outpatient
assessment

2.

Semi-Urgent/Routine

Pleural effusion

Chest xray report, duration

and severity of symptoms,
smoking history.

Consider non-pulmonary
causes, eg. heart failure.
Refer all cases for assessment
if likely to be a pulmonary
problem

1.

Urgent/Semi-Urgent

Pneumonia

Significant symptoms and

signs, co-morbidities, xray
changes, social circumstances,
smoking history.

Refer if:
Diagnosis uncertain
Poor response to standard
therapy
Significant co-morbidities and
poor social circumstances
Persistent xray changes
following treatment

2.

Semi-Urgent

Consider admission if severe

eg. confusion, tachypnoeic,
tachycardiac

1.

Urgent

Pneumothorax

History of any underlying

pulmonary diseases, degree
of symptoms, xray report if
any, smoking history.

Refer for hospital assessment

in emergency department

1.

Urgent

Primary bronchial carcinoma

History of smoking and

asbestos exposure, comorbidity such as airway
disease, coronary artery
disease, chest xray changes,
blood test results if available.

All suspected cases should be

referred

1.

Urgent

Pulmonary embolism

Risk factors, including

previous surgery, malignancy,
immobility, family history,
signs and symptoms of DVT.
Symptoms and signs
including chest pain,
breathlessness, tachypnoea,
hypotension.

Refer to hospital emergency

medicine department for
consideration of admission

1.

Urgent

Pulmonary nodules

Smoking history, past history

of malignancy, chest xray
report, blood test results if
available, old chest xray if
available

All cases should be referred

1.

Urgent/Semi-Urgent

Sarcoidosis

Any extra pulmonary

symptoms or signs. Chest xray
changes. Blood test results
including calcium, mantoux.

Referral for assessment and

management

1.

Urgent/Semi-Urgent/

Risk factors, if any, including

immigrant status, ethnicity,
immunosuppression,
diabetes, alcohol and drug
abuse, chest xray changes,
results of mantoux, TB smears
and cultures if available.

All patients with suspected

tuberculosis should be
referred

1.

Tuberculosis

Routine

Urgent/Semi-Urgent

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R E S P I R AT O R Y M E D I C I N E
National Referral Guidelines
NATIONAL REFERRAL GUIDELINES : RESPIRATORY MEDICINE SYMPTOM BASED
Respiratory Systems

Evaluation

Possible Diagnosis

Acute Respiratory Symptoms

Consider non pulmonary causes, check for

general symptoms of infection and
thromboembolic risk factors. Look for
central cyanosis, hypotension, tracheal
deviation, shift of apex beat, reduction
of breath sounds, signs of pleural effusion/
consolidation, pleural rub, wheezes.

Pulmonary embolism, pneumothorax,

pneumonia, asthma.

Smoking history, decreasing exercise

tolerance, chronic productive cough,
spirometry.

Chronic obstructive pulmonary disease.

Smoking history, haemoptysis, weight loss,

asbestos exposure, clubbing,
lymphadenopathy, abnormal chest xray.

Bronchial carcinoma.

Progressive exertional dyspnoea, clubbing,

crackles on auscultation, chest xray
changes, spirometry, co-existing systemic
diseases, occupational/environmental
exposure.

Diffuse parenchymal lung diseases.

Breathlessness, chest pain, stony dullness

on percussion, fluid on chest xray.

Pleural effusion.

Persistent purulent sputum, recurrent

haemoptysis, episodic fever, malaise and
pleuritic pain, local or bilateral crackles,
finger clubbing.

Bronchiectasis

Chronic cough, fever and night sweats,

weight loss, haemoptysis, history of TB
contact and other risk factors, chest xray
changes especially apical.

Tuberculosis

Persistent cough with

normal CXR

Trigger factors, relation to external

allergens, exercise and temperature
change. Current or previous smoking.
Medications, especially ACE inhibitors and
beta blockers. Symptoms of
gastroesophageal disease, signs of airflow
obstruction on examination, spirometry
results.

Smoking related airway disease,

asthma, chronic rhinitis/sinusitis,
gastroesophageal reflux disease.

Haemoptysis

Exclude epistaxis and haematemesis.

Assess quantity and frequency of the
haemoptysis. Check for any accompanying
symptoms dyspnoea, pleuritic pain,
systemic symptoms.

Bronchial carcinoma, tuberculosis,

bronchiectasis, pulmonary infarction,
pneumonia, alveolar haemorrhage.

eg dyspnoea, chest pain

Chronic Respiratory
Symptoms

Version 1 Respiratory Referral Guidelines and Priorisation Criteria Date: 24/10/2000 Authorised: Elective Services, HFA