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General Medicine

Find assessment and management information on General Medicine conditions at:

Emergency Immediate transfer to the Emergency Department

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergent medical advice if in a remote region.


  • 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 <0.5 x 10⁹/L
    • Haemoglobin <70g/L
    • Platelets <20 x 10⁹/L


  • 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.

Cognitive Impairment and Dementia

  • Very rapid onset of cognitive +/- other neurological symptoms
  • Suspected delirium deemed unsafe to manage in the community by the treating medical practitioner
  • Imminent safety risk to self or others

Complex paediatric patients transitioning to adult services

  • Any sudden decompensation in clinical condition that carries risk of serious adverse events or death

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 temperature ≥ 39°C
  • 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


  • 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/poly-pharmacy

  • Anaphylactic or other serious adverse drug event
  • Markedly prolonged heart rate adjusted QT interval which may herald pro-arrhythmic event
  • Marker 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 ischemic attack or stroke based on focal neurological deficits
  • Delirium or acute confusional state
  • Severe headache or altered level of consciousness with sudden onset


  • Syncope/pre-syncope with any following concerning features:
    • Exertional onset
    • Chest pain
    • Persistent symptomatic hypotension (systolic BP <90mm)
    • 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+ <3.0mmol/l, corrected Ca+ ,<1.6 or > 3.0mmol/l, Mg+ <0.4mmol/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


  • Any condition defined by other CPCs as requireing referral to emergency

Are you referring to the right service?

For children 16 years and under, referrals should be made to General Paediatrics or Children’s Health Queensland. Please refer to the paediatric catchment area search tool to determine most appropriate pathway.

Urgent referrals Arranging urgent review

To arrange an urgent review, please phone the relevant hospital’s switchboard and ask to speak to the Registrar of the relevant specialty.

Out of scope services

The following are not routinely provided in a public General Medicine outpatient service.

  • Clearly evident mental health disorders requiring psychiatric consultation
  • Genetic testing/counselling - refer to Genetics (Metro North Refer Your Patient)
  • Requests for respite care, ACAT assessments or other forms of assessment or supportive care in the presence of established diagnoses and management plans, or where patients with established mental capacity to make decisions refuse such assessments or care
  • Reviews relating to workers’ compensation claims, NDIS eligibility, disability pensions, driving license renewals or other legal and administrative procedures
  • Reviews relating to drug withdrawal or detoxification


  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 28 November 2022