Referrals

The criteria below are guides regarding which patients should be considered for a referral to other specialists beyond the POAC for medical reasons. If a patient triggers consideration for referral, inform the consultant on duty of this fact.

Endocrinology

Patients who have a raised BMI or a diagnosis of Diabetes Mellitus (type 1 or 2) may require a review by an endocrinologist or specialist nurse practitioner. The endocrinology team should be contacted by email to endocrine@beaconhospital.ie if:

  • HbA1c > 69mmol/L
  • patient uses an insulin pump


Cardiology

There are two scenarios in which a referral to cardiology should be considered. In each of these cases, the patient is assumed to not be under the current care of a cardiologist. If they are under the care of a cardiologist and fall into either of these two categories below, then they should be referred to that cardiologist.

New or uncontrolled arrythmia

These are usually processed by Dr. Jonathan Lyne.

  • NEW
    • atrial fibrillation/atrial flutter/tachycardia of unclear origin
  • UNCONTROLLED
    • known atrial fibrillation with heart rate >90 or <50

Next steps

  1. arrange echo for patient
  2. get thyroid function tests
  3. scan patients ECG

Ischaemic Heart Disease

These are usually processed by Dr. David Burke. The following applies to any patient who:

  1. has a history of ischaemic heart disease (previous MI, coronary artery disease, stents, previous CABG…) AND:
  2. is NOT under the current care of a cardiologist and has no review within the past 24 months

Next steps

  • Arrange echo for patient
  • Refer for cardiology appointment


Nephrology

A patient should be considered for referral to a nephrologist if there is evidence of low or deteriorating renal function, in the absence of a diagnosis of a renal disorder, and in the absence of that patient being under the care of a nephrologist at present.

Patients who fit the following criteria should be considered for referral to Dr. Rory McQuillan:

  • eGFR < 45, and no diagnosis of renal disease exists
  • Hb < 11 AND Cr > 120


Haematology

If any haematological criteria on the review of blood tests trigger a review by a consultant anaesthesiologist, then consideration should also be given to referring that patient to a haematologist (assuming they are not under the care of a haematologist for a condition already diagnosed).

These referrals and reviews are usually conducted by Dr. Patrick Hayden.


Patients GP

This is usually to ask the GP to review the management of the patients blood pressure, and will be noted on the POAC assessment form.