DGRI Referrals

Inpatient Referrals

1. All need a reason for referral with presenting complaint, past and drug history and any important findings on examination and relevant results. COTE need some functional information as well.

Alcohol Withdrawal

1. First port of referral should be through Cortix. Currently Mary Gibson is the only liaison nurse working (33090). Failing this can contact admin team on 34555.

Cardiology

1. Flag all CAU patients with ACS/suspected ACS with a ‘review requested’ under Cardiology on the electronic whiteboard before the 0830 ward round
2. Cardiology will see patients with HF and arrhythmia on CAU after they have been reviewed by the CAU consultant but it is important to let cardiology know asap.​The consultant cardiologist also does a ward round at 1600 and will see any further admissions at this time. Out with these times if a patient needs an urgent cardiology review switchboard will be able to let you know who the on call consultant is to call. Alternatively you can phone the Cardiology Specialist Nurses, Sue Bryant (33149) or Mel Branney (33892)
3. To access the Rapid Access Chest Pain Clinic, send the IDL to Sue or Mel, or an email with the patients details so they can see the IDL ([email protected] or [email protected]). Sue or Mel will triage these referrals, asking the secretaries to book them into appropriate clinic. If you are sending a patient home with suspected angina please ensure you prescribe appropriate medication including GTN spray. Click here for the link to the referral criteria for the RACPC. If you are sending a patient home with suspected angina please ensure you prescribe appropriate medication including GTN spray.
4. Patients requiring referral to the heart failure service will also be seen by Consultant Cardiologist but to avoid then being missed, the juniors can leave a message on the heart failure nurses’ answer phone (34312).  The HF nurses are not based in the hospital but do retrieve their messages regularly throughout the day.  All patients with LV systolic dysfunction should be started on the heart failure referral form which includes a reminder to refer to the heart failure service. ​

Care of the Elderly

1. Care of the Elderly ask that you refer patients to [email protected]
2. You may also contact Angela Haining, Secretary, on 33349 and provide patient details and a reason for referral. Angela will direct the referrals to the appropriate consultant.
3. Parkinson’s referrals are as per the Parkinson’s section further down the referral finder

Dermatology

1. Dermatology is an outpatient-based service available for advice within weekday working hours of 9:00- 17:00 only
2. There is NO on call dermatology
3. All advice referrals must be through email :- [email protected] Please include photographs, patient CHI and full medical history of current admission.
   All email referrals must be discussed with team’s consultant with the team consultant copied into email before referring to Dermatology.

Diabetes & Endocrinology

1. The Diabetes Team has a single number for inpatient diabetes advice: Inpatient Diabetes Team 32413
2. Advice is available Monday through Friday 0930 – 1530.
3. Many queries can be managed over the phone – it is always helpful to have patient CHI number, type of diabetes, current treatment, recent capillary glucose readings and most recent HbA1c to hand.  Lab HbA1c testing can take up to 3 Days to process.
4. Requesting early review in admission for all patients with sub-optimal diabetes control or those commencing high dose steroids is always advised.

Endoscopy

1. Emergency endoscopy (haemodynamic instability and active bleeding) referred to general surgical registrar on call
2. Phone patient access (33834) if you need an urgent (within 48h) or inpatient upper or lower GI scope. Sheree True is the endoscopy secretary and will usually manage to fit a patient in fairly quickly. She will ask you to complete one of two forms: either the Upper GI bleed Endoscopy for Inpatient Form or the Endoscopy Request Form

Gastroenterology

1. Please email [email protected] for all inpatient referrals, review or advice.  The secretary will forward to the relevant Consultant for action/reply/review of the patient.

General Surgery

1. Contact switchboard and ask for general surgical registrar on call. Available 24h a day, 7 days a week

Haematology

1. Phone switchboard to be put through to the on call haematologist. Drs Thomas, Crowther and Ames are on call for a week at a time and are happy to take calls from juniors

Infectious Disease

1. The duty consultant can be contacted via the ID Secretary on 33840 Mon-Fri 0900-1700.

Mental Health Liaison Referrals

1. Click here for advice on how to do this

Microbiology

1. Email referrals can be made to [email protected] during normal working hours Monday to Friday. Please ensure you have the required information to hand. The use of this form is recommended: Microbiology Referral Form
   • Information required in email:
     • Referrer name, phone number/extension to receive call back
     • Patient name, CHI, location
     • A few words or sentence describing reason for advice request, for example:
     • Investigation of infection
     • Antimicrobial choice (empirical or definitive)
     • Antimicrobial duration, dosing, therapeutic drug monitoring
     • Requesting further sensitivities
2. It is particularly important to include imaging results, known allergy to antimicrobials and the nature of the allergy
3. Depending on the complexity, a response will be either by return email or phone call. Duty Microbiologist will respond as soon as practicably possible to emails sent between 9.00am – 4.30pm Monday to Friday.  Any emails received after 4.30pm will be attended to the following working day.
4. For more urgent microbiology queries that you would like to discuss over the phone, please phone ext. 33294.
   • Before phoning for specialist advice from the on-call Microbiologist, please ensure you have checked the empirical antibiotic guidance on Beacon and discuss the case with a senior clinician if appropriate.
5. Out of Hours advice given by phone via DGRI switchboard. Please remember this service is for urgent advice that cannot wait until the next working day.   

Neurology

1. Neurology is an Outpatient based service available for advice within weekday working hours of 9:00am – 5:00pm. 
2. There is no on call neurology service.  If there is no Consultant available during these times, any urgent cases should be discussed with the on call Neurology service at the Royal Infirmary of Edinburgh (via switchboard).
3. Referrals should be made via email to [email protected] or Consultant to Consultant by telephone on either ext 33069 or 33628 or via the Neurology secretary on 33087.
4. MS Specialist Nurse (ext 33272) will only see patients who have a previous definitive diagnosis of MS.  New or suspected MS cases should be discussed with Consultant Neurologist in the first instance.
5. Epilepsy Nurse (ext 33013) will only see patients who have an established diagnosis of epilepsy.  New or suspected epilepsy cases should be discussed with Consultant Neurologist in the first instance.
6. EEG is not performed in Dumfries.  For outpatient referrals patients should be referred to Crosshouse Hospital in Kilmarnock.  Urgent inpatient EEGs should be discussed with on call service in Edinburgh (via switchboad).
7. If patient requires an urgent neurophysiology study (nerve conduction or EMG) as an inpatient then send this form (Inpatient Neurophysiology Referral Form) to [email protected].

Neuro-oncology

1. Please see Guidance for the Management of Intracranial Tumours in the Acute Setting – NHS Lothian for advice on when to refer and to whom.
2. Referral forms for NHS Lothian Neuro-oncology.  ECNO Referral Form     Brain Mets Referral Form
3. IMPORTANT – Details MUST be typed onto the form and not handwritten or referrals will not be processed and will be returned. 
4. Once completed, the form should be saved and sent as a Microsoft Word document and not as a pdf or other scan.

Neurosurgery

1. Refer to Neurosurgical Registrar at Royal Infirmary of Edinburgh.   Switchboard 0131 536 1000.

Oncology Nurse Specialists

1. Important to let the oncology nurse specialists know when a cancer patient is admitted. Phone numbers are as follows:

Ophthalmology

1. You can call the Eye Clinic Monday to Friday during working hours. 
2. After 5pm the calls go to the on call Ophthalmology consultant.  
3. Alternatively you can email at [email protected], which is checked every day.  
4. If the referral is not urgent for that day or next then you can put a referral in through Sci store/gateway. 

Palliative Care

1. To make a referral to the hospital team, please contact switchboard who will put you through to the member of the team on call. 
2. To make a referral to the community team please contact the palliative medicine secretaries who will forward a referral form. Referrals can also be made via RMS for community.
3. We also need to know about anyone going home with a syringe driver to organise Marie Curie cover (not available in Wigtownshire but we would still need to know to explain what to do OOH).

Parkinson’s Disease

1. Phone call to Parkinson’s specialist nurses Shona Graham or Laura Chapman (33909). Dr Shona Donaldson also available (32111)

Renal

1. Phone 32177 for renal on call 9-5pm. Phone switchboard if you need a renal opinion out of hours

Respiratory – Specialist Nursing referrals – Phone 32007/31576

1. For admission avoidance, self management including inhaler technique, Early Supported Discharge (ESD) and oxygen issues in patients already on home oxygen or already known to the nursing team/respiratory team.

Respiratory – Doctor referrals – Phone 31000

1. There is not an on-call Respiratory team but we have a consultant or speciality doctor level (with consultant cover) covering for referrals and advice during working hours.
2. Any referrals to respiratory should be discussed with a senior member of the team (middle grade or above) prior to referral.
3. We cannot offer a service where we see acutely unwell Respiratory patients as routine. In Medicine these patients should be looked after by their own team and escalated to CCU under that team if appropriate. We would be happy to offer advice and input if there are ongoing complex respiratory issues or support is needed, but are not responsible for managing these patients initially. Escalation decisions should be made by the responsible team but again we would be happy to discuss if there are complex issues.
4. Acutely unwell patients on surgical wards who need medical assessment should be referred to the 2nd on for Medicine and not directly to Respiratory. Patients can then be referred on if needed.
5. We will attend CAU daily to review the details of any patients due to come to B2 under Respiratory in order to prioritise patients to the beds. This does not mean we will see these patients and if you wish a patient to be seen by the medical team then please refer on 31000 as early in the day as possible.
6. We will attempt to see any Respiratory referrals the same day, unless referrals are received late in the day, in which case they will be seen on the next working day.
7. On working days we will review and take over the care of any patients on NIV in CCU if appropriate and we have adequate cover within the Respiratory team. Care remains under the admitting team until such time as they are seen by Respiratory and taken over. If you feel that Respiratory review is needed for a CCU patient then please refer to us directly.
8. Handover of any sick patients (ie: High News) who are being transferred for CAU to B2 should be discussed by ringing the referral phone. Similarly step down patients from CCU can be discussed through this number

TIA/Stroke

1. Phone 32065 for one of the specialist nurses Christine Cartner, Karen Smith or Simone McClymont between 8:30am and 5pm Monday to Friday. Dr Malik also available on 32191 until 5pm. Out of hours contact the on call physician.
2. If patient is being discharged before review by stroke team then refer by email to [email protected] remembering to include name, CHI and reason for admission.

Urology

1. There are no urology middle graders on site and the urology service is provided by two consultant urologists. 8am-4pm referrals should be made via switchboard to the consultant urologist on call
2. Out of hours and at weekends urgent referrals are made to the general surgical registrar on call. If specialist urological input is needed OOH you might be asked to discuss with urology team based in Ayr

Vascular

1. Nurse specialists Shirley Wight 33833 and Julie Rutherford 33296 as first port of call. If not available please contact on call general surgical registrar.

Links

• Endoscopy Referral Form[pdf]
• Inpatient Care of the Elderly Referral Form[pdf]
• Oupatient Referral Form[pdf]
• Upper GI Bleed Referral Form[pdf]
• Inpatient Neurophysiology Referral Form [pdf]

Content by Dr Nadeeka Rathnamalala