The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the \u201cright place by the right person, the first time\u201d<\/p>\n\n\n\n
Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty. We recognise that this decision is often not clear cut at time of referral and that these onward referrals are sometimes inevitable because of the complex nature of our caseload and the type of service we provide. These guidelines have been devised to help this process and hopefully allow the most appropriate referrals from the outset. We are always happy to discuss grey areas and complex cases. See details regarding how to contact the on-call consultant by phone and how to seek email advice below.<\/p>\n\n\n\n
General medical clinics are held in OPD 2 at the Royal Infirmary of Edinburgh.<\/p>\n\n\n\n
We aim to see urgent referrals<\/strong> within two to four weeks<\/p>\n\n\n\n Routine referrals are seen within the 12 week guarantee<\/p>\n\n\n\n More urgent referrals<\/strong><\/span> (e.g. rapid deterioration in a patient’s condition), which may require inpatient assessment should be referred for assessment via the Flow Centre<\/a>.<\/p>\n\n\n\n Telephone advice<\/strong><\/p>\n\n\n\n Any cases that are not clear cut or require a second medical opinion can always be discussed with:<\/span><\/p>\n\n\n\n General Medical E-mail Advice Service<\/strong><\/span>:<\/strong> RIEacutemedicine@nhslothian.scot.nhs.uk<\/a><\/p>\n\n\n\n Admission and Alternatives to Admission<\/strong> \u2013 see below under Who not to refer section.<\/p>\n\n\n\n D.I & B.I – 06-04-26<\/strong><\/p>\n\n\n\n All referrals should be made via Sci-Gateway: <\/p>\n\n\n\n RIE > General Medicine > LI Basic Sign Referral<\/p>\n\n\n\n It is appropriate to refer patients with:<\/p>\n\n\n\n We recognise that there are many patients who are over the age of 65 years who are fit and independent with few comorbidities and often a general medical referral is appropriate for them.<\/p>\n\n\n\n Those over the age of 65 with multiple comorbidities and multifactorial conditions (eg dizziness, falls, non-specific symptoms) are better assessed by the Medicine for the Elderly team<\/a> <\/p>\n\n\n\n Patients known to (or who have already been referred to)<\/strong> other services<\/strong> and have ongoing specialty-specific issues. <\/p>\n\n\n\n Patients with rapidly declining symptoms<\/strong>. Please consider admission or alternatives to admission listed below <\/strong>or discuss with the Medical Interface Team consultant on-call (available via switchboard) or the on-call Consultant for General Medicine (on weekends or bank holidays).<\/p>\n\n\n\n Allergy Issues<\/strong><\/p>\n\n\n\n Primary Immune Deficiency<\/strong> and C1 inhibitor deficiency (hereditary angioedema)<\/strong> – refer to Immunology<\/p>\n\n\n\n Mast Cell Activating Syndrome<\/strong><\/p>\n\n\n\n MCAS has been characterised by episodic signs and symptoms of systemic anaphylaxis \/ symptoms associated with mast cell degranulation that concurrently affect at least two organ systems.<\/p>\n\n\n\n MCAS tends to be a patient-led diagnosis characterised by a variety of ill-defined criteria with no specific diagnostic tests to support a formal diagnosis. Some patients benefit from anti-histamines which should be trialled if this is a potential diagnosis, but there is limited treatment beyond this option and as there are no formal diagnostic tests. Further investigation is not warranted. <\/p>\n\n\n\n A detailed consensus document on MCAS can be found at AAAAI Mast Cell Disorders Committee Work Group Report: Mast cell activation syndrome (MCAS) diagnosis and managementopens a new window<\/a> (2019)<\/p>\n\n\n\n Chronic fatigue <\/strong>– please consider referral to appropriate service: Chronic Fatigue Syndrome: ME-CFS \u2013 RefHelp<\/a><\/p>\n\n\n\n Night Sweats – patients with:<\/strong><\/p>\n\n\n\n We are amenable to reviewing patients who have night sweats in the context of normal FBC and constitutional symptoms that suggest a non-haematological malignancy. Please ensure that the recommended primary care investigations are followed prior to referral (see link here to Night sweats \u2013 RefHelp<\/a>)<\/p>\n\n\n\n Syncope likely to be –<\/strong><\/p>\n\n\n\n Cardiogenic cause<\/em><\/strong> – refer to Cardiology. Suspect if:-<\/p>\n\n\n\n Palpitations<\/strong> with a likely endocrine<\/strong> or cardiac <\/strong>cause. Refer to appropriate specialty. General Gastrointestinal presentations<\/strong> e.g., microcytic anaemia, diarrhoea, altered bowel habit, dysphagia and dyspepsia: https:\/\/apps.nhslothian.scot.nhs.uk\/refhelp\/Gastrointestinal<\/a><\/p>\n\n\n\n Generalised musculoskeletal pains<\/strong> polyarthralgia, polyarthritis, and muscle stiffness: Rheumatology and Bone disease \u2013 RefHelp<\/a><\/p>\n\n\n\n There is always a General Medical Interface Team consultant<\/strong> who operates at the RIE on all working weekdays between 8am and 8pm. \u00a0We carry an Interface Team mobile phone 0131 242 1735 or can be accessed via switchboard and are happy to support a prof-to-prof discussion for patients who are not clear cut. \u00a0We endeavour to either review patients on the same day or advise on whether clinic or ambulatory care are suitable alternatives to admission.<\/p>\n\n\n\n The Flow Navigation Centre<\/strong> also helps to support the flow of patients across the acute sites and there are useful links to alternatives to admission on their RefHelp page:\u00a0<\/strong>Flow Navigation Centre \u2013 RefHelp<\/a><\/p>\n\n\n\n https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Information-for-patients-with-dropping-blood-pressure-Orthostatic-Hypotension-v1.0-1-1.pdf<\/a><\/p>\n\n\n\n https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Advice-for-patients-who-tend-to-faint-Vasovagal-Syncope-v1.0.pdf<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" General Medicine RIE The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the “right place by the right person, the first time” Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty. We recognise<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3664,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[219],"class_list":["post-3960","page","type-page","status-publish","hentry","category-generalmedicine"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" General Medicine<\/a>","rttpg_excerpt":"General Medicine RIE The following guidelines are aimed at ensuring effective and efficient use of services, so that patients get seen promptly in the “right place by the right person, the first time” Sometimes we review patients in the General Medical Outpatient Clinic and then refer directly on to another more appropriate specialty. 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<\/ul>\n
How to refer:<\/h4>\n\n\n\n
Who to refer:<\/h4>\n\n\n\n
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https:\/\/apps.nhslothian.scot.nhs.uk\/refhelp\/Haematology\/Anaemia\/AnaemiaNormocytic<\/a>
<\/li>\n<\/ol>\n<\/li>\n\n\n\n
<\/li>\n\n\n\n\n
Who not to refer:<\/h4>\n\n\n\n
\n
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Neurological cause<\/strong><\/em> – primariy seizure disorders. Refer to general neurology or first seizure clinic:- <\/a>First Seizures and Epilepsy \u2013 RefHelp<\/a><\/p>\n\n\n\n
Arrhythmia and palpitations \u2013 RefHelp<\/a><\/p>\n\n\n\nAlternatives to Admission:<\/h4>\n\n\n\n
Other alternatives are:-<\/h4>\n\n\n\n
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