General Internal Medicine

In the setting of COVID-19, the Division of General Internal Medicine has significantly increased the proportion of ambulatory care being provided by virtual means.

When new referrals are received, they will be triaged by an attending internist as requiring virtual versus inpatient assessment.

  • Please advise your patient at the time of referral that the majority of new referrals will be seen on a virtual basis (either video via Zoom telehealth or phone), unless the triaging internist is confident that in-person examination will change management.
  • In-person follow-ups may be offered based on the initial virtual assessment on an as needed basis.
  • If you have a clinical question that does not require internist assessment of the patient, please request a provider to provider phone consultation in your referral letter.

 

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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