Peripheral arterial disease

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Useful Management Information

Advance health directive  (where available)
Diabetic foot ulcer: High-risk foot clinic (referral via podiatry and access via telehealth available – Statewide Diabetes Clinical Network will provide details)
Asymptomatic peripheral arterial disease especially tibial artery stenosis or occlusion when the foot is healthy and the symptoms are proximal to the lesions in non-diabetic patients, do not warrant referral and can be managed conservatively with risk factor modification and exercise therapy. Other causes for the more proximal leg pain should be sought.
Atherosclerosis risk factor management (antihypertensive; diabetes, dyslipidemia)
Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)
Claudication with no impact on quality of life should be managed conservatively with risk factor control, graduate exercise therapy and anti-platelets

Minimum Referral Criteria

Category 1	Claudication <50m Peripheral aneurysm above the treatment threshold
Category 2	Intermittent claudication with no signs of limb-threatening ischaemia >50m Asymptomatic peripheral aneurysms below the treatment threshold Significant impact on quality of life
Category 3	Asymptomatic upper limb arterial disease
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

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, BMI), 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.)

Essential Referral Information

History (if relevant) including:
- incapacitating claudication distance
- rest pain
- ischaemic changes
- any antiplatelet medication regime
- Peripheral pulses: femoral/popliteal/foot
Risk factors particularly smoking and diabetes (if relevant)
Recent cardiac tests, including stress test results
Duplex USS scan results (Cat 1 case only)
U&E
FBC & coags
BSL
Lipid profile

Additional Referral Information

Homocysteine level (HbA1C if diabetic)

Send Referrals To

Smart Referrals

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Internal Referrals

Vascular Surgery (E-Blueslip)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.