General Internal Medicine

ATTENTION: All physicians in NSHA Central Zone

RE: Referrals to General Internal Medicine

March 18, 2020

Dear colleagues,

Due to our anticipation of an influx of inpatients with COVID-19 infections, the Division of General Internal Medicine will not be accepting non-urgent ambulatory referrals at this time given the urgent need to reallocate our workforce capacity to acute inpatient management. This will be re-evaluated on April 15, 2020 with high likelihood of a prolonged extension. We are also cancelling all non-urgent follow-up appointments.

Semi-urgent and urgent referrals will still be accepted. In order to reduce the risk of transmission, whenever possible non-face-to-face consultations will be undertaken. Please advise your patients that these assessments will be conducted virtually by phone or video visit unless it is certain that a physical examination would alter our recommendations.

We will continue to be available on call in the case that you require our urgent assistance. We will also be offering phone consultations for non-urgent referrals if you feel that specialist advice is required within the coming weeks. If you would like to arrange a phone consultation, please fax a request to 473-8430 with the referral question and your general availability. We ask that you please not page our on-call staff for non-emergent issues given that our limited capacity will be dedicated to the care of acutely ill inpatients.

Common indications for non-urgent referrals to our service include but are not limited to: chronic fatigue, asymptomatic lab abnormalities, palpitations without red flags, chest pain in young people with no risk factors or red flags, chronic stable anemia, hypertension, abdominal pain without red flags, and fatty liver. If a referral is received that we deem to be non-urgent, you will receive a notice from our office confirming that it will not be accepted at the present time.

Thank you for your collaboration and understanding.

The Division of General Internal Medicine

Department of Medicine, Dalhousie University

Triage criteria and referral process for physicians

General Internal Medicine

Emergent

Likely requires hospital admission

Criteria (not all inclusive)
  • Hemodynamic instability
  • Hypoxemia
  • Infection requiring IV antibiotics
  • Unstable acute illness
Process
1) Must call the SENIOR INTERNIST ON CALL via locating (902-473-2220)
 
Facilitators
2) Written note summarizing assessment given to patient to bring to emergency department
Urgent

Requires rapid assessment as clinically unstable but not hospital admission

Criteria (not all inclusive)
  • Hypertensive urgency
  • Rapidly progressive medical illness
  • High suspicion of malignancy
Process
1) Call the GENERAL INTERNIST/CONSULT STAFF ON CALL via locating (902-473-2220) and
2) FAX referral
 
Facilitators
3) If patient from emergency department
Semi-Urgent

High risk of becoming unstable

Criteria (not all inclusive)
  • Profound anemia (Hgb <80)
  • Chest pain with risk factors
  • Decompensated complex chronic disease
  • Acute undifferentiated inflammatory process
Process
1) FAX referral to 902-473-8430
 
Facilitators
2) Detailed referral note with clinical question prompting referral and ideally includes:
  • risk factors,
  • presence or absence of red flags,
  • all relevant past medical history,
  • medications,
  • exam and laboratory findings, and
  • goals of care
Routine

Stable but requiring timely assessment

Criteria (not all inclusive)
  • Anemia potentially requiring intervention (Hgb 80-100)
  • Shortness of breath
  • Chest pain without risk factors
  • Complex multimorbidity
  • Peri-operative assessment
  • Hypertension with potential secondary causes
Process
1) FAX referral to 902-473-8430
 
Facilitators
2) Detailed referral note with clinical question prompting referral and ideally includes:
  • risk factors,
  • presence or absence of red flags,
  • all relevant past medical history,
  • medications,
  • exam and laboratory findings, and
  • goals of care
Non-Urgent

Very low risk of becoming unstable

Expect a prolonged wait time (at least 3 months)
Note: These referrals may be triaged to a non-face-to-face consult (see next category).

Criteria (not all inclusive)
  • Fatigue without red flags
  • Palpitations without red flags
  • Abdominal pain without red flags
  • Second opinion related to chronic stable condition
Process
1) FAX referral to 902-473-8430
 
Facilitators
2) Detailed referral note with clinical question prompting referral and ideally includes:
  • risk factors,
  • presence or absence of red flags,
  • all relevant past medical history,
  • medications,
  • exam and laboratory findings, and
  • goals of care
Non-face-to-face consult

Phone consultation / eConsult / letter summarizing recommendations

Criteria (not all inclusive)
  • Chronic symptoms with low risk of organic condition requiring intervention
  • Essential hypertension
  • Asymptomatic or stable, chronic laboratory abnormalities
  • Request for advice establishing next steps
Process
1a) FAX referral requesting phone consult or submit an eConsult via MyHealthNS;
OR
1b) Can also call the consult general internist on call (902-473-2220) for immediate phone consult but will require written referral note to be faxed (902-473-8430) at same time
 
Facilitators
2) Detailed referral note with clinical question prompting referral and ideally includes:
  • risk factors,
  • presence or absence of red flags,
  • all relevant past medical history,
  • medications,
  • exam and laboratory findings, and
  • goals of care

Please note: We do not accept referrals for discharge follow-up or routine primary care issues based on lack of access to a family doctor alone.

 

Immunology

Urgent / Non-Urgent
Process

1) Call or send referral to
Phone: 902-425-3927
Fax: 902-425-3928
2) Note any relevant history, lab data, etc.

 

Contact information

  General Internal Medicine
Fax 902-473-8430
Location 4th floor Dickson Building, VG Site
General Internists View list of all physicians
Forms GIM Emergency Department Rapid Access Clinic Referral Form
  Immunology
Phone 902-425-3927
Fax 902-425-3928
Location 5657 Spring Garden Road

 

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