Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • fever (≥ 38°C), systemic symptoms and painful swollen knee
  • pain following trauma where fracture is suspected
  • rapidly worsening symptoms
  • sudden onset acute pain that is not improved by rest and/or pain so severe that weight bearing is not possible
    Note: consideration to be made to osteonecrosis, metastatic cancer, septic arthritis or fracture.
  • unable to differentiate an acute swollen knee from infection with serious pain.

When public outpatient services are not routinely provided

  • Clinical symptoms not severe enough to require surgical opinion for intervention.
  • Osteoarthritis where non-operative management has not been undertaken.
  • Patient already on surgical waitlist in another local health district for the same condition.
  • Uncomplicated inflammatory arthropathy (including crystal arthropathies)
    Note: consider referral to rheumatology.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Severe bilateral knee osteoarthritis (as indicated by severe knee pain, night disturbance and/or limited mobility).
  • Severe difficulty in completing activities of daily living.
  • Unexplained, severe knee pain (for example possible malignancy, impending fracture).
  • Patient highly likely to present to an emergency department due to challenges with activities of daily living.

Category 2
Recommended to be seen within 90 calendar days.

  • Severe functional impairment that persists despite optimal non-surgical management (for example after 6 months of demonstrated supported exercise regime and weight loss attempt if indicated).
  • Severe unilateral knee osteoarthritis (as indicated by severe knee pain, night disturbance and/or limited mobility).

Note: Patients are strongly encouraged to have undertaken a trial of non-operative management (for example weight management, exercise and physiotherapy, optimisation of health co-morbidities) prior to referral

Category 3
R​ecommended to be seen within 365 calendar days.

  • Patient who is unable to access non-operative pathways by alternative means.
    Note: consider referral to an Osteoarthritis Chronic Care Program.
  • Moderate knee osteoarthritis (as indicated by moderate knee pain, no night disturbance and/or coping with symptoms).

Note: Patients are expected to have undertaken a trial of non-operative management (for example exercise and physiotherapy, optimisation of health co-morbidities) prior to referral

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including symptoms and their duration, severity, location of pain and impact on function.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • evidence of significant impact on knee pain and function
    • details of past non-operative management received
    • x-ray: knee series (including weight bearing and patella) within last 6 months of referral.
      Note: consider referred pain to knee from hip or spine prior to referral.

If available

  • MRI result: knee (if suspected locked knee or significant internal or ligamentous derangement).
  • Medical and/or allied health reports.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is willing to have surgery (where clinically relevant).
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Monday 17 June 2024
Contact page owner: System Purchasing