Referral/Discussion

Question 1

First thing in referral?

Answer 1

Introduce:
Explain name, role and division
Confirm who you are talking to
Explain what you want from them:
- See a patient on ward
- Advice over the phone
- Take over care
- Perform investigation
- See a patient in clinic

Question 2

Structure for referral?

Answer 2

Situation
Background (admission and history)
Assessment
Recommendation

Question 3

Situation

Answer 3

Patient details (name, age)
Patient location
Major problem at the moment

Question 4

Background

Answer 4

Admission details: date, reason, treatments
PMHx
Any other relevant history: drugs, premorbid state, allergies

Question 5

Assessment

Answer 5

Vital signs/obs
Examination findings
Investigations received and pending
Management so far

Question 6

Recommendation

Answer 6

Diagnosis/differentials
Management plan
What you require of them

Question 7

Example

Answer 7

Hello, it’s ___, the FY1 on medicine/surgery.
Can I just check who I’m talking to?
I am phoning to ask if you would review one of out patients on the ward for consideration for transfer to ITU.

The patient is Mr Ronald Steward, a 59 year old man currently on ward 1 with severe hypotension.

He was admitted 3 days ago for CAP for which he is on amoxicillin and clarithromycin, He is normally fit and well and has a history of well controlled mild asthma

His BP is 85/45 despite 3L of IV fluids over the last 2 hours. He has only had 3ml of urine output over the last hour. He is oxygenating fine and not pyrexial.
On examination, he is drowsy, confused, with cool peripheries and coarse right lower lobe crepitations on auscultation.
I have done an ABG showing a lactate of 4.
We have also sent bloods and repeat cultures, which we are awaiting results.

I think he has septic shock and wonder if he need inotropic support to maintain his BP.
I’d be grateful for your input.