Bayside Referral Assist

Eligibility

At least one must be met for the patient to be eligible for referral.

Patients who are being treated for the same condition at another Victorian public hospital

Children under 18 years of age, unless previously treated at Alfred Health

Patients experiencing degenerative spine pain only, and no presence of limb pain or neurological deficit unless significant instability on imaging i.e. severe malalignment or dynamic instability [movement on flexion/extension imaging] that potentially carries a risk of spinal cord or cauda equina compression)

Patients with degenerative spine conditions where appropriate conservative strategies have not been optimised (in the absence of motor deficits)

Patients with scoliosis (refer to Orthopaedics)

Patients not wanting to consider surgery

Severe or progressive low back pain with either:

persistent or increasing radicular symptoms despite at least three months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where required)

progressive neurological deficit(s) for example, lower limb weakness such as foot drop, abnormal lower limb tone

worsening neurogenic claudication (reduced walking distance or time)

signs of serious pathology

Acute development of peripheral nerve compression symptoms following trauma

Neurogenic injury confirmed by nerve conduction study with either:

severe disabling symptoms with weakness and wasting

rapid progression

unresponsive to at least three months of medical management (that is at least two of hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection, oral steroids, alone or in combination)

Recurrence of neurogenic injury after surgical decompression

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Routine referral criteria

Determine Category 2 or 3 urgency.

Initial primary-care work-up complete (history, examination, baseline investigations per Alfred guideline)

Symptoms persist or progress despite primary-care management

Usually managed in primary care

Patients who are being treated for the same condition at another Victorian public hospital
Children under 18 years of age, unless previously treated at Alfred Health
Patients experiencing degenerative spine pain only, and no presence of limb pain or neurological deficit unless significant instability on imaging i.e. severe malalignment or dynamic instability [movement on flexion/extension imaging] that potentially carries a risk of spinal cord or cauda equina compression)
Patients with degenerative spine conditions where appropriate conservative strategies have not been optimised (in the absence of motor deficits)
Patients with scoliosis (refer to Orthopaedics)
Patients not wanting to consider surgery
Low back pain that is not progressive
Low back pain where at least three months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where required) has not been trialled
Referrals based on incidental findings found on imaging without clinical significance
Diagnosis of carpal tunnel or other nerve compression syndromes unconfirmed by nerve conduction study where at least three months of medical management (that is at least two of hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection or oral steroids, alone or in combination), has not been trialled
Presence and duration of neurological symptoms and signs including evidence of lower limb spasticity
Work status
Weight loss, appetite loss and lethargy
Fever and sweats
Treatment to date
Previous malignant disease
General medical condition Investigations (only if indicated):
Plain x-ray, CT & MRI Please note: Medicare provides a rebate for MRI cervical spine for cervical radiculopathy or trauma in patients over 16 years of age when requested by a General Practitioner
Plain x-ray & CT
Diagnosis unconfirmed by nerve conduction study
Where at least three months of medical management (that is at least two of hand therapy, orthotics/splinting, ergonomic modifications, local steroid injection or oral steroids, alone or in combination), has not been trialled
Refer to the full Alfred Health PDF guideline for complete inclusion / exclusion criteria, required investigations and triage categories.

Neurosurgery referral