COVID-19:
Due to the COVID-19 pandemic, Respiratory Medicine will continue to contact review/follow-up patients with upcoming outpatient appointments to change their appointment to a telephone (or Near-me). Where face-to-face consultations are absolutely necessary, these will be accommodated but may not be at the usual location.
For new patients, the guidance for urgent and non-urgent referrals has not changed and we encourage referrals to be made. However;
- For non-urgent referrals most diagnostics tests (lung function, CT) may not be done in the COVID period. Please refer, but let your patient know that they may not receive any appointments for at least a few weeks.
- Please indicate that ‘advice only’ would be sufficient
- Almost all referrals should come through SCI gateway, but if advice is required within 24 hours, you are strongly recommended to use email for RIE or St John’s referrals (RIE.Respiratoryoncall@nhslothian.scot.nhs.uk) (SJH.Respiratory@nhslothian.scot.nhs.uk). You can also email individual consultants if you have done this before, but please use alternative pathways if you receive an OOO message.
For advice that is deemed urgent and requires a response in real-time, please contact the on-call SpR or consultant on a site-by-site basis. For all other types of referral/advice please use the options above.
For both follow-up and relevant new referrals, we will try to relay shielding advice directly to the patient and cc you in. We will attempt to identify patients that we consider may benefit from an ACP and/or KIS update and advice you of this.
You and you patients may find the following respiratory COVID guidelines and statements useful
https://www.blf.org.uk/support-for-you/coronavirus
https://www.brit-thoracic.org.uk/about-us/covid-19-information-for-the-respiratory-community/
Also, please see updates to Chronic Cough pathway.
Services
Patients with respiratory disease are referred to the Respiratory Medicine Clinics in the Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, St. Johns Hospital at Howden, Livingston.
Referral can also be made to the Respiratory Rapid Response Team (Community Respiratory Team, CRT) based at Astley Ainslie Hospital.
Referral can also be made to the Pulmonary Rehabilitation Teams based at Leith CTC and St John’s.
Patients can also be referred separately for simple lung function and medication compliance checks to RIE, WGH and Leith CTC.
In all cases referrals can be made via SCI Gateway.
Advice Only
Services
- There is the facility to refer for ‘ADVICE ONLY’ for respiratory issues
- There are dedicated ‘advice/virtual’ clinics at RIE, St John’s and WGH
- At the RIE there is an email inbox that is looked at every day for quick response to respiratory queries
Who to refer:
- Patients where the GP thinks the patient does not necessarily need to be seen in person, but would like advice on management or further investigations
Who not to refer:
- Patients that require to be seen in person in respiratory clinic
How to refer:
- Use SCI and mark ‘advice only’ for RIE, St John’s or WGH
- Email RIE.Respiratoryoncall@nhslothian.scot.nhs.uk for quick responses to respiratory queries
Who to refer:
Urgent
- If it is suspected that a patient has lung cancer link see the www.cancerreferral.scot.nhs.uk and the SIGN Guidelines for lung cancer referral
- Asthma difficulty in diagnosis treatment advice for poorly controlled asthma/exacerbations.
- Suspected COPD / respiratory failure
- Onset of cor pulmonale confirm diagnosis
- Frequent exacerbations of COPD – 2 or more per year optimise therapy
- Rapidly course of disease (rapid decline in FEV1, progressive dyspnoea, decrease in exercise tolerance) encourage early intervention
- Haemoptosis exclude carcinoma
Non-urgent
- Asthma
- COPD diagnostic uncertainty to confirm diagnosis
- Diagnostic uncertainty for long term oxygen therapy / optimise therapy
- Assessment for nebuliser therapy and appropriate prescription
- Aged under 40 years or a family history of alpha-1-antitrypsin deficiency identify alpha-1-antitrypsin deficient patient consider therapy.
- Uncertain diagnosis make a diagnosis
- Symptoms disproportionate to lung function deficit look for other explanation
- Frequent infections exclude bronchiectasis
- Bullous lung disease identify candidates for surgical intervention
- Assessment for pulmonary rehabilitation – identify candidates for exhabilitation
- Assessment for lung volume reduction surgery identify candidates for LVRS
- Assessment for lung transplantation identify candidates for lung transplantation
- Recurrent lower respiratory infection
- Dysfunctional breathing confirm diagnosis, advice on pharmacology therapy
- Interstitial lung disease advice on diagnosis and treatment
- Persistent respiratory symptoms where diagnosis is unclear
- Persistent cough
- Recurrent lower respiratory infection
Who not to refer:
- Airways disease well controlled symptoms / no change in symptoms
- Cough in a non-smoker less than eight weeks duration
How to refer:
Where
Use Gateway for referral to these services
- Royal Infirmary of Edinburgh, Respiratory Medicine Clinics
- Western General Hospital, Edinburgh, Respiratory Medicine Clinics
- St. Johns Hospital, Howden, Livingstone, Respiratory Medicine Clinics
- Leith CTC, Respiratory Medicine Clinics
