Respiratory  |  Elective Services




Respiratory

Elective Services

Respiratory referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to triage referrals can be found under Access Criteria.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is a follows:

First Specialist Assessments

 

Waiting priority 1A 

Accepted

Waiting priority 1B

Accepted

Waiting priority 2A

Declined

Waiting priority 2B

Declined

Waiting priority 3

Declined

 

Access Criteria:

 

Criteria

Examples

Notes

1A Urgent (High suspicion of cancer)

Suspected Neoplastic disease with OR WITHOUT significant symptoms.

  • Suspected lung cancer.
  • Recent significant haemoptysis.
  • SVC obstruction.
  • Symptomatic/progressive pleural effusion.
  • Suspected neoplastic pleural disease eg
    • Symptomatic/progressive chest wall pain with contributory imaging in a patient previously exposed to asbestos

FSA within 2 weeks as per MoH guidelines.

Note: Aim to ensure CT and lung function organised/requested at time of grading

1B Urgent

(non cancer)

Serious infections.

 

Other SERIOUS respiratory pathology.

  • Possible active pulmonary TB.
  • Suspected infective pleural disease/lung abscess
  • Pulmonary/systemic vasculitis.
  • Primary pulmonary hypertension.
  • Acute or rapidly progressive interstitial lung disease.
  • Subacute upper airways obstruction
  • Grading physician to indicate time frame at grading but likely to be 2-4 weeks
  • Consider acute admission if indicated
  • Some conditions may be appropriate within with 1B or 2A category depending on the clinical scenario

2A Semi -urgent

(ideal timeframe within 3 months)

Disabling, unstable or progressive airways disease not requiring admission but needing specialist assessment.

 

 

Paediatric - adult transfer.

  • Severe COPD with complications.
  • Difficult to control asthma.
  • New diagnosis of interstitial lung disease.
  • Known Bronchiectasis with recurrent admissions
  • Active sarcoidosis

  • Cystic Fibrosis.
  • Consider whether Respiratory Nurse clinic may be appropriate
  • Aim to formally transfer and have dual physician attendance at Paediatric clinic prior to transfer

2B Semi -urgent

(ideal timeframe within 4 months)

Major/moderate function impairment with moderate clinical risk requiring assessment and review.

  • Chronic cough with other issues eg purulent sputum, abnormal chest x-ray, suspected important underlying disease.
  • Major GP diagnostic respiratory dilemmas.
    • Dyspnoea of uncertain cause.
    • Major /moderate respiratory disease associated with or complicating extra-pulmonary disease.

 

  • Major/moderate respiratory muscle impairment.
  • Major chest wall deformity.
  • Some scenarios may be appropriate for  1Bor 2A eg progressive MND with likely development of respiratory failure
  • Consider Respiratory Nurse led clinic eg chronic cough, unexplained dyspnea not already investigated.

3 Routine

Past history suggests mild-moderate functional impairment where specialist advice is likely to be sufficient

  • Mild to moderate COPD.
  • Pleural plaques.
  • "Stable" radiologic abnormalities.
  • Chronic cough without important other issues.
  • Consider development of 'standard' forms of documentation and/or use of Bay Navigator or other pathway tools to provide advice.

 



Last updated : Friday, June 29, 2018
Next review date : Saturday, June 29,2019


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.