Wounds of traumatic aetiology

• Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
• 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
• Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects

Arterial/ischaemic ulcer

• Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools
• 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 (Sepsis Clinical Tools)
• Worsening pain and all pain not in keeping with current state 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, including peristomal varices, not controlled with usual measures
• Stomal change in colour from red / pink to blue or black
• Stomal prolapse causing circulatory compromise
• 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 (Sepsis Clinical Tools)
• Worsening pain and all pain not in keeping with current state of the wound
• Pressure injury causing and systemic infection
• Patients with spinal injuries should be referred to Spinal Outreach Team (SPOT)

Patients from Residential Aged Care Facilities can access wound advice from RADAR services (Residential Aged Care District Assessment and Referral Service) where they are established

Post-operative wound/dehiscence

• Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Prosthesis / metal work / mesh is on view/ vascular bypass procedure
• Tendon blood vessel or other structure on view
• Purulent discharge with associated fevers
• Immunocompromised patients
• Deep sinus or fistula present

Referral to Surgeon who performed operation/Surgical Clinic

Patients should have clearance from their surgeon for wound management alone if:

• Acute wound dehiscence in the post operative period (< 6 weeks)

Venous leg ulcer

• Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Progressive cellulitis despite treatment – rapidly spreading cellulitis with peri-wound redness or erythema (colour change, warmth, tight oedema, or pain in pigmented skin tones) for > 2cm
• Uncontrollable bleeding from ulcer

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

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
• All conservative options that have been pursued unsuccessfully prior to referral
• 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
• Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
• Current medications and dosages
• Drug allergies
• Alcohol, tobacco and other drugs use

Patient's Demographic Details

• Full name (including aliases)
• Date and country of birth
• Residential and postal address including whether patient resides at an aged care facility
• Telephone contact number/s – home, mobile and alternative
• Medicare number (where eligible)
• Name of the parent or caregiver (if appropriate)
• Name of delegate and contact details (Department of Corrective Services)
• Preferred language and interpreter requirements
• Identifies as Aboriginal and/or Torres Strait Islander
• Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

• Full name
• Full address
• Contact details – telephone, fax, email
• Provider number
• Date of referral
• Signature
• Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)