Referral Guidance DIRECT REFERRAL SERVICE FOR THE ELDERLY DEAF

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1 Referral Guidance A & E GPs are strongly requested to contact the specialty teams DIRECTLY WHEN APPROPRIATE to avoid unnecessary delays for their patients in A & E. Relevant non-urgent conditions can be given an early A & E clinic appointment to see a consultant. If the surgery contacts the department, an appointment time will be given over the telephone on ext The patient may then present with a letter at the appropriate time and will be booked in for their appointment. AUDIOLOGY DIRECT REFERRAL SERVICE FOR THE ELDERLY DEAF The Direct Referral Service is specifically designed for those patients with simple age-related sensorineural deafness, who meet the referral criteria (see below). Initial assessments are undertaken by Senior Audiologists and include a case history, otological examination and an audiological evaluation. Patients meeting a second set of criteria then have an aural impression taken and are subsequently fitted with a hearing aid. Those not meeting this criteria are referred on to the ENT department for a medical opinion. Referrals

2 Referrals should be made on the standard form contained within the Direct Referral Information Booklet (available from this department) together with a referral letter routinely used by the GP practice. Referrals should be sent directly to the Audiology Department. Please provide the necessary information for patients requiring transport. Referral Criteria There is an agreed GP protocol for the direct referral of the elderly deaf requiring hearing aids: 1. Patients should be 60 years of age or over 2. Patients should be examined by their GP: - wax should be removed from both ears as and when necessary - examination should reveal normal eardrums 3. Patients should show no evidence of: - sudden onset of deafness - history/signs of active discharge from either ear - otalgia affecting either ear - vertigo - previous ear surgery - fluctuating hearing loss (not associated with the common cold) - continued tinnitus - any other unusual presenting feature, ENT or hearing abnormality Audiology Referrals

3 Patients with hearing problems should be referred either to ENT or the Audiology Department in the usual manner. If a hearing aid is prescribed, patients can choose to purchase a private aid, in addition to, or in place of the NHS aid. Patients wishing to specifically use the private service many contact the department directly, without any referral from the GP. However, if certain medical conditions were found to be present, patients would be referred back to their GP. NB: This service is available at the Audiology Department or in the patient s own home for those people not physically able to get to the hospital. CARDIOLOGY Outpatient Referrals letter) and sent to the Health Records department of the appropriate site marked with the degree of urgency. CLINICAL HAEMATOLOGY Referrals Patients can be referred by letter, fax or telephone to the consultant s secretary. Emergency admissions to the ward can be arranged by discussion with the consultant or registrar.

4 Existing patients are able to refer themselves to the clinic or day ward if necessary. The senior medical team provide 24-hour cover for haematology patients and for advice to colleagues. They can be contacted out of hours via the DRI switchboard on (01332) Anticoagulant Referrals Contact Sister Salinder Gill or Sister Kate Welch on (01332) ext 2796 or (01332) Monday to Friday between 8.45am and 5.00pm. Alternatively they can be contacted via bleeps 3427 / 3426.

5 CLINICAL ONCOLOGY Referrals Patients can be referred by letter or telephone to the consultants secretary. Emergency admission to the ward can be arranged by discussion with the consultant or Ward 17 SHO s. Existing chemotherapy patients are able to refer themselves to the clinic or ward if necessary. DERBYSHIRE CHILDRENS HOSPITAL Referrals Routine Referral for Consultants To be addressed to the New Referrals Department, Derbyshire Children s Hospital, Uttoxeter Road, Derby. Urgent Referrals For outpatient appointments telephone or ext Urgent referrals can be faxed to

6 Emergency Referrals Ring and ask for first, on-call for paediatric medical referrals or second, on-call for paediatric surgical referrals. Direct Access Referrals Physiotherapy Specialist Paediatric Physiotherapy services are not available elsewhere in Derby on Direct Access. Services are available Monday to Friday, 8.00am 12.00pm and 1.00pm 4.00pm. Direct dial telephone number Psychology Services are available Monday Friday, 9.00am 5.00pm. This applies to both the Children s Hospital and the Ronnie MacKeith Centre. Referrals are to be addressed to Sue Rhead, Director of Clinical Psychology. X-Ray Services available: Monday and Wednesday 9.30am 12.00pm and 2.00pm 4.00pm Thursday Friday 9.30am 12.00pm 2.00pm 4.00pm Direct dial telephone number

7 Orthoptic Services Secondary orthoptic screening service is provided for 0 8 year olds. Primary orthoptic screening service for children aged 3 4 years old is provided in the community in partnership with Child Health Services Audiology Community Audiology Services can be contacted on DERMATOLOGY Referrals Outpatient letter) and sent to the Health Records department marked with the degree of urgency. For adult referrals please send to the DRI, for children s referrals send to the Health Records department at the Children s Hospital. Suspected Skin Cancers Suspected skin cancer referrals (Melanoma and SCC) should be made using the standard letter contained in the Referral Guidelines for Suspected Cancer and faxed to the department DIABETES

8 Outpatient Referrals letter) and sent to either the Health Records department at the DRI (medical outpatients referrals) or the Jenny O Neill Centre (Diabetes referrals) marked with the degree of urgency. The following specialist clinics can be accessed via routine clinics held in the Diabetes Unit: erectile dysfunction, painful neuropathy (acupuncture), nephropathy, ante-natal, nurse-led pump clinic, tablets to insulin groups, clinical psychology, sensor clinic, low calorie diet clinic, elderly clinic. Urgent Referrals (eg newly diagnoses young patients likely to need insulin) should be made by telephone to the Diabetes Unit or one of the consultants secretaries.

9 ENT Referrals letter) and sent to the Health Records Department at the DRI marked with a degree of urgency. If you wish to discuss an urgent case you can contact the doctor on-call. For any information relating to a patient s appointment contact the nursing staff or the medical secretaries. GASTROENTEROLOGY Outpatient Referrals letter) and sent to the Health Records Department of the appropriate site marked with a degree of urgency. Very urgent requests should be telephoned to the consultant secretary or by the 2- week cancer route if appropriate. GENERAL SURGERY

10 Referrals Routine Referrals Outpatient referrals should be made using the standard letter (see preferred example referral letter) and sent to the Health Records department of the appropriate site marked with the degree of urgency. Please refer to Clinic Schedules below for correct site. Urgent Referrals For emergency or urgent outpatient clinic referrals, the consultants should be contacted through their secretaries on the numbers shown above. Breast Surgery Referrals Regular Radiological and Surgical outpatient clinics are held at the Breast Unit for symptomatic breast referrals. Referrals should be made by letter directly to the Breast Unit and not to General Surgery. All referrals for patients which are deemed clinically urgent should be faxed directly to the Breast Unit (Fax: ). GUM Referrals Patients may self-refer by using the Walk In service between 9.00am 10.00am Monday to Friday, or 2.00pm 3.00pm Monday and Thursday. Referrals should be made using the standard form and sent direct to the clinic at the Derbyshire Royal Infirmary.

11 Cross referrals are made to and from Gynaecology, Haematology and other specialties. IMAGING Referrals Plain Film Radiography Appointment not necessary, patients should present to : X-Ray 1 DRI 9.00am 12.00pm 2.00pm 4.30pm Monday Friday only Main X-Ray DCGH 9.00am 12.00pm 2.00pm 4.30pm Monday Friday only Children s X-Ray 9.00am 12.00pm 2.00pm 4.30pm Monday, Wednesday, Thursday and Friday only

12 All patients must have an appropriately completed and signed request form, giving sufficient relevant clinical information as to justify the examination. Ultrasound Examinations General Ultrasound Examinations Appointments are required for Ultrasound examinations. Request forms should be sent direct to the Ultrasound Department at either the DRI or DCGH site. Patients will be notified with a suitable appointment time. Requests for clinically urgent examinations should be telephoned to either Ultrasound Department: DRI DCGH All patients must have an appropriately completed and signed request form, giving sufficient clinical information to justify the examination. Obstetric Ultrasound 1 st Trimester: confirmation, viability & dating scans, up to 18 weeks Appointments are required for these examinations. Appointments can be booked directly by telephone by referring clinician or midwife ( ), or by sending a request form. All patients must have an appropriately completed and signed request form, giving sufficient clinical information to justify the examination. 2 nd & 3 rd Trimester 18 week to term Appointments are required for these examinations. Appointments can be booked directly by telephone by referring clinician or midwife ( ), or by sending

13 a request form. All patients must have an appropriately completed and signed request form, giving sufficient clinical information to justify the examination. GI and other Contrast Examinations Appointments are required for these examinations. Request forms should be sent direct to X-Ray 2 at the DRI or main X-ray at DCGH. Patients will be notified of a suitable appointment time. Requests for clinically urgent examinations should be telephoned to: DRI DCGH Bone Densitometry Appointments are required for these examinations. Request forms should be sent direct to Bone Densitometry, Main X-Ray at DCGH. Patients will be notified of a suitable appointment time. CT Examinations Appointments are required for these examinations. Request forms should be sent direct to CT Department at the DRI, or Main X-Ray at DCGH. Patients will be notified of a suitable appointment time. BREAST CANCER REFERRALS

14 Urgent suspected Breast Cancer referrals should be faxed on the correct Derby Cancer Centre referral form, direct to the Breast Unit on These cases are seen within 14 days. Guidelines for urgent referrals include: New lump especially age greater than 30 years Dimpling or distortion or changes in the shape of the breast Nipple retraction Routine non-urgent requests GPs should refer by letter, direct to the Breast Unit. These referrals are usually seen within 4 weeks. Family History referrals these should be made on the FHGP referral form and can then be acted upon appropriately. KINGS LODGE Referrals Medical Consultants, General Practitioners and Health Professionals can make referrals for elective admissions and/or assessment of needs either by phone or in writing. MEDICINE FOR THE ELDERLY Outpatient and Domiciliary Referrals

15 Letters must state if ambulance transport is required and indicate if an escort will be in attendance. Derbyshire Royal Infirmary Referrals letter) and sent to the Department of Medicine for the Elderly, Bed Bureau, DRI. Letters may be named or un-named and should indicate urgent or non-urgent. Urgent referrals to the DRI consultants can also be telephoned / faxed via Bed Bureau. Derby City General Hospital letter) and sent to the Health Records department, DCGH. For urgent referrals to DCGH, please telephone the consultant s secretary. Community Hospital Clinics letter) and sent to the individual hospitals concerned. Day Hospital Referrals

16 Please use the same system as for outpatient referrals. NEUROLOGY / NEUROSURGERY letter) and sent to the Health Records Department at the DRI marked with a degree of urgency. Very urgent requests should be telephoned to the consultant secretary. NUTRITION AND DIETETIC SERVICES Referrals should be made using either the dietetic referral form or by letter. All referrals must be completed with patient details including medical condition and signed by a registered medical practitioner. Across the two sites, there are general dietetic outpatient clinics held at specific times on NUTRITION TEAM SERVICES Referrals should be made in writing, including patient details, medical condition and reason for referral and sent to the Dietetic or Nutrition department. A registered medical practitioner should sign all referrals.

17 OCCUPATIONAL THERAPY Patients can be seen by appointment between 8.30am and 4.30pm, Monday Friday and by arrangement outside these hours. Referrals can be made on the normal referral letter. For further information or to arrange appointments for your patients please contact the GP Liaison Team. Urgent outpatient referrals refer by marking the referral letter or by direct contact with a consultant or the senior registrar. Out of hours contact please telephone the DRI switchboard on OMF letter) and sent to the Health Records Department at the DRI marked with a degree of urgency. For urgent appointments within clinic hours (9.00am 5.00pm) call For urgent referrals out of hours please call the hospital switchboard on and contact the Oral Surgery Senior House Officer on call.

18 OPTHALMOLOGY Referrals should be made using the standard referral letter (see preferred example referral letter) and sent to the Health Records department marked with the degree of urgency. For adult referrals please send to the DRI, for children s referrals send to the Health Records department at the Children s Hospital. Acute Emergency Cases with a history of less than 48 hours should be sent to Eye Casualty (situated within the Eye Clinic) with a referral letter. The Eye Casualty is open Monday to Friday between 9am and 4.30pm. Urgent Appointments with the consultant can be arranged following discussion with the Sister or Nurse in charge. If you wish to discuss a case with the doctor, please contact eye casualty on (01332) or the doctor on-call out of hours. PAIN MANAGEMENT GPs may refer their patients by letter. Direct dial clinic telephone number is (24 hour answering machine). PALLIATIVE MEDICINE Outpatients

19 Referrals may be made to Dr Keeley, Dr Hocknell or Dr Swanwick in writing, by fax or by telephone. PATHOLOGY For microbiology, patient appointments can be arranged between 9.00am and 4.30pm, Monday to Friday. Please telephone Medical advice on haematology problems is available from one of the consultant haematologists. PHYSIOTHERAPY Referrals are taken for any musculo-skeletal condition, however, patients suffering from the following types of problems would particularly benefit from the service: Acute spinal conditions Work related conditions Stress incontinence Recent soft tissue injuries Sports injuries Patients can be seen by appointment between 8.00am and 5.00pm, Monday Friday in the adult service at either the DRI or DCGH and from 8.00am and 4.30pm at the Children s Hospital. Referrals with the appropriate patient information should be sent to:

20 GP Liaison Team Therapy Services Physiotherapy Department DRI Physiotherapy Department DCGH Physiotherapy Department Children s Hospital PLASTIC SURGERY Referrals should be made using the standard letter and sent to the Derbyshire Royal Infirmary marked urgent or routine. Urgent requests and queries should initially be directed to the secretary at the DRI. Patients requiring inpatient plastic surgery will be admitted to Nottingham City Hosptial. Urgent requests can also be made to the plastic surgeon secretary on ext REHABILITATION MEDICINE

21 letter) and sent to the Health Records Department of the appropriate site marked with a degree of urgency. Urgent outpatient referrals refer by marking the referral letter or by direct contact with a consultant or the senior registrar. Out of hours contact please telephone the DRI switchboard on RENAL MEDICINE Urgent referrals may be made by telephoning the consultant secretary or contacting the renal registrar or consultant. Referral letters can be sent directly to the Renal Unit at the DCGH. RESPIRATORY MEDICINE letter) and sent to the Chest Clinic marked urgent or routine. Very urgent requests should be made directly to the sister or TB health visitor. Cancer 2 week referrals to be faxed as per proforma. RHEUMATOLOGY

22 letter) and sent to the Health Records Department at the DRI marked with a degree of urgency. Urgent outpatient referrals should be made by marking the referral letter or by direct contact with a consultant or the registrar. Inpatient admissions are normally non-emergency and may be discussed with a consultant or the registrar. Out-of-hours consultant contact please contact the DRI switchboard on to speak to the on-call consultant. T & O letter) and sent to the Health Records department at the DRI marked with the degree of urgency. If the patient s condition gives cause for concern or deteriorates, the first point of contact is the consultant s secretary. UROLOGY Referrals should be made using the standard referral letter (see preferred example referral letter) and sent to the Health Records department at the DCGH site marked with the degree of urgency.

23 For emergency or urgent outpatient clinic referrals, the Consultant should be contacted through their secretaries on the above numbers.

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