Fiona Stanley Hospital Update

Changes to outpatient rheumatology referral acceptance at FSH, RGH, RPH and AHS

There are extended waitlists for new patient rheumatology appointments at Fiona Stanley Hospital, Rockingham General Hospital, Royal Perth and hospitals.

In order to see patients within a more appropriate timeframe, referrals will now only be accepted for patients who appear to have an autoimmune/ inflammatory condition. Referrals should contain information to support these possible diagnoses including:

  • The rheumatological differential diagnosis
  • Relevant clinical history and examination findings
  • Results of relevant blood tests and/or radiology reports.

Referrals not including this information will be rejected. GPs may find the Rheumatology suite of HealthPathways useful. The on-call Rheumatology registrars at FSH (for SMHS- via Helpdesk 6152 2222) or RPH (for EMHS-via Switchboard 9224 2244) are available to discuss urgent referrals or cases of concern.

Dr Monica Lacey
Hospital Liaison GP, Fiona Stanley Hospital
monica.lacey@health.wa.gov.au(08) 61524731

Mondays and Thursdays

October 2020
Low-risk penicillin allergy delabelling within a GP setting – A pilot project with Fiona Stanley Hospital Immunology

Did you know?

  • More than 90 percent of patients with a penicillin allergy label do not have a true penicillin allergy.
  • Unnecessary avoidance of penicillins leads to poorer clinical outcomes.
  • Patients with a low-risk (e.g. benign, distant rash) reaction to penicillin are best assessed with an oral amoxicillin challenge, without skin testing.
  • Oral challenge in low-risk patients has been shown to be safe. The risks are comparable to iron transfusion, immunotherapy, and vaccinations.
  • The oral challenge process takes two – three hours.

The Immunology Department at Fiona Stanley Hospital (FSH) is looking to work with a small number of practices within the Perth metropolitan area who will be interested in performing direct oral amoxicillin challenges within their practices from February 2021. The FSH Immunology Department will provide the necessary training and support for participation in the pilot project.

To register your interest or to find out more, please email Xiang on zhi.leang@health.wa.gov.au

FSH GP contact list

Some departments have recently made changes to their preferred contact details for GPs seeking clinical advice and/or arranging early outpatient review as well as routine departmental enquiries. Download the contact list on the Fiona Stanley Hospital Website

A reminder that NaCS discharge summaries, most Outpatient letters, pathology and radiology results may now be accessed via My Health Record for most patients and there may not be the need to formally request such information from the hospital.

Dr Monica Lacey
Hospital Liaison GP, Fiona Stanley Hospital
monica.lacey@health.wa.gov.au(08) 61524731

Mondays and Thursdays

November 2020
FSH Virtual Immunology Clinic

In recent months, Fiona Stanley Hospital (FSH) has offered suitable immunology clinic patients the option of a specialist consultation via telephone/video call. In some cases, a follow up call is given during a GP consultation where the results of initial investigation and treatment can be assessed and an ongoing management plan discussed. It is hoped that this will improve patient experience and access as well as provide an educative/upskilling opportunity for the referring GP.

A survey of patients seen in the traditional outpatient and the Virtual Immunology Clinic (VIC) showed that the feedback from the VIC group was overwhelmingly positive. Ease of access, shorter waiting times, the quality of the consultation and less disruption to work and school were consistently expressed in comments.

Only two patients experienced a degree of technical difficulty.

GPs whose patients have been seen in the VIC will soon be sent a short survey to allow feedback and comments about this initiative. This will be attached to a copy of the outpatient letter containing outcomes and the management plan. It would be very much appreciated if these surveys were completed and returned by fax or email.

Dr Monica Lacey
Hospital Liaison GP, Fiona Stanley Hospital
monica.lacey@health.wa.gov.au(08) 61524731

Mondays and Thursdays

July 2020
New FSH Rapid Access Thyroid Clinic

A new Rapid Access Clinic for assessment of urgent endocrine surgical patients within one week of referral is now available at Fiona Stanley Hospital (FSH). Referral for the following conditions should be discussed and sent directly to the hospital via the Urgent Endocrine Surgical Referrals process (below):

Thyroid:

  • Thyroid mass and:
  • Sonographic ATA intermediate or high risk of thyroid cancer
  • Cytology showing malignant thyroid cancer or suspicious thyroid cancer
  • FDG-PET positive thyroid nodule
  • Rapid nodule growth
  • Symptomatic airway compromise or stridor
  • Unexplained hoarseness or voice change.
  • Cervical lymphadenopathy
  • Personal history of neck irradiation
  • Family history of thyroid cancer or endocrinopathy
  • Severe Graves’ disease that is medically uncontrollable.

Parathyroid

  • Hyperparathyroidism with severe hypercalcemia over 3.0.
  • Hyperparathyroidism in pregnancy.

Adrenal:

  • Adrenocortical cancer or highly suspected adrenocortical cancer
  • Large adrenal mass ( over 4cm)
  • Pheochromocytoma or paraganglioma
  • Cushing’s syndrome

Lymph node:

• Lymphadenopathy and suspected lymphoma

For urgent endocrine surgical referrals, directly contact the Endocrine Surgical Registrar via the FSH Helpdesk on 6152 2222. Once accepted these should be marked “Urgent Rapid Thyroid Access Clinic” and emailed to rapidaccessthyroidclinic@health.wa.gov.au or faxed to 6152 9762.

This referral information is also available on the “Acute Endocrinology Assessment” HealthPathway.  See also “Thyroid Nodules and Goitre”, and “Neck Lumps”.

Most of these patients will be seen within 30 days and assessment will be made using a one-stop model where appropriate. This involves same-day clinical assessment, ultrasound, FNA and cytology. Routine endocrine surgical referrals should be sent via CRS in the usual manner.

Dr Monica Lacey
Hospital Liaison GP, Fiona Stanley Hospital
monica.lacey@health.wa.gov.au(08) 61524731

Mondays and Thursdays

 

March 2020
New FSH Virtual Immunology Clinic to reduce patient wait times

A new model for providing specialist immunology advice for suitable patients referred to immunology at Fiona Stanley Hospital (FSH) will be piloted in 2020.

After triaging of referrals sent via CRS, selected patients will be offered a phone consultation with an immunology consultant at an appointed time (Monday to Friday mornings). Initial assessment, investigation and management will be provided and a follow-up appointment arranged three weeks later.

On this occasion the patient will have been asked to make a longer appointment with the referring GP. A video call using smart phone, tablet or computer webcam made through secure channels will allow review and an ongoing management plan to be formulated by the consultant and GP in the presence of the patient.

It is anticipated that this process will replace a physical outpatient clinic attendance in most cases and markedly reduce the time a patient would normally wait for an appointment.

No change to usual GP referral practices will be required. Feedback will be sought from referrers and patients who engage in this new model of outpatient access.

 

Dr Monica Lacey
Hospital Liaison GP, FS & FHG
monica.lacey@health.wa.gov.au
Available: Monday and Thursday

October 2019
New rapid access giant cell arteritis clinic

FSH and RPH are combining to provide patients living in both catchments with early access, investigation and management of suspected giant cell arteritis.

Inclusion criteria includes:

  • Aged over 50 years
  • Presence of suggestive features e.g. new headache, jaw claudication, scalp sensitivity, tenderness over the temporal arteries, fever, visual disturbance, PMR, raised ESR/CRP
  • No other more likely diagnosis
  • Within the SMHS or EMHS catchment (and related country areas)

To refer:

  1. Please call the on-call rheumatology registrar (in hours) or consultant after hours via the RPH switchboard on 9224 2244 to discuss the referral, whether to start steroids and for an appointment time to be allocated.
  2. The referral form including patient and GP information is available on the RPH website (and soon on the FSH website) and fax to 6477 5199 or email OutpatientReferrrals@health.wa.gov.au
  3. The GCA Clinic appointment information (attached to the on-line referral form) should be given to the patient with the appropriate clinic time ticked.

The on call Rheumatology registrar/consultant should still be called for referrals for all patients with suspected giant cell arteritis.  Patients with transient or persistent loss of vision for whom immediate review in clinic is not available may be advised to attend the RPH ED for urgent assessment. Other patients will be seen at RPH within 72 hours of referral whenever possible.

Dr Monica Lacey
Hospital Liaison GP FSHFH
monica.lacey@health.wa.gov.au
Available: Monday and Thursday


Midwifery-led care for low risk pregnancies

August 2019
Women in the South Metropolitan catchment who meet the clinical criteria for a low risk pregnancy and due to deliver on or after 11 November 2019 can now receive midwifery-led care throughout the antenatal, labour, birth and postnatal periods.

The Family Birthing Centre offers three birthing suites containing birthing pools, birthing cubes and silks, day beds and family lounge facilities. The aim is to provide access to active physiological birth with the support of the same midwife throughout the process.

 GPs can request the Family Birthing Centre in their FSH referrals or women can self-refer by phoning 08 6152 9416, or emailing Fsh.FamilyBirthingCentre@health.wa.gov.au

 

Dr Monica Lacey
Hospital Liaison GP,Fiona Stanley and Fremantle Hospital Group
monica.lacey@health.wa.gov.au
Available: Monday and Thursday


FSH Fracture Liaison Service Project

June 2019
An average of 60 female patients over 50 years of age present to Fiona Stanley Hospital with a minimal trauma upper limb fracture every month. This project hopes to capture those attending orthopaedic outpatient clinics to provide education on osteoporosis, diet and exercise and commencing treatment.

The aims of the project include:

  • Finding sustainable solutions within the orthopaedic outpatient clinics to reduce secondary fracture rates (potentially up to 40 per cent);
  • Improving patient outcomes and quality of life; and
  • Improving communication between health care providers to develop individualised treatment pathways for fragility fracture patients.

 GP input into the project is invited to inform the communication, information-sharing and development of ongoing management and monitoring pathways crucial to the success of the initiative. Contacts:

Clinical Nurse Specialist Project Officer- lisa.welthy@health.wa.gov.au

Orthopaedic Registrar – david.kelly@health.wa.gov.au

Geriatric Consultant – hannah.seymour@health.wa.gov.au

Dr Monica Lacey
Hospital Liaison GP,Fiona Stanley and Fremantle Hospital Group
monica.lacey@health.wa.gov.au
Available: Monday and Thursday

 

Paediatric Advice at FSH

May 28 2019
A reminder the on call Paediatric consultant is available to GPs to discuss patients requiring rapid access for assessment or management but who may not need to present to the Emergency Department.

Patients for whom an outpatient referral is currently in place, but where the GP wishes to escalate the urgency of the referral can also be discussed with the on-call consultant (or the treating consultant if known) rather than sending additional written information or another referral.

PRAM – Paediatric Rapid Assessment and Management

Ph: 6152 7674 8am-4pm Mon-Fri and
8am-Midday Sat.

Dr Monica Lacey
Hospital Liaison GP,Fiona Stanley and Fremantle Hospital Group
monica.lacey@health.wa.gov.au
Available: Monday and Thursday

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