Primary care urgent referral
From primary care it will be clear that some patients with conditions or presentations require infectious diseases expertise and assessment, eg unwell febrile returned travellers or patients with potential meningitis. In these cases direct referral to the local infectious diseases unit is the best option. For some patients the option of ambulatory intravenous antibiotics for certain acute conditions, typically cellulitis, means infectious diseases clinicians are able to facilitate care for the patient in the community or at home.
Other primary care referral
Newly diagnosed patients with long-term infections such as HIV and viral hepatitis can be seen promptly in clinic within a week to ensure they have been assessed. For stable long-term patients, virtual clinics or specialist nurse support clinics together with primary care management are new ways of managing these conditions. Most infectious diseases units have urgent clinic slots or ambulatory assessment facilities that can be accessed by primary care after liaison with the infection team.
Most infectious diseases services see new referrals from the acute medical take each day, in addition to those patients who are admitted directly to the infection service. Patients admitted via the acute medical take are reviewed the same or next day after admission and many infectious diseases services have a list of conditions that the acute team automatically refer to them. The following list includes examples of conditions suitable for infectious diseases services input or management:
- illness in returned travellers eg malaria, typhoid, viral illness, diarrhoea
- HIV infection-related problems
- suspected infection in other immunocompromised patients
- proven or suspected tuberculosis (as agreed locally with respiratory team)
- proven or suspected viral hepatitis (as agreed locally with gastroenterology)
- pyrexia of unknown origin (PUO) or acute undifferentiated febrile illness
- systemic infection eg glandular fever, leptospirosis, rheumatic fever
- sepsis or severe sepsis not requiring critical care
- neurological infections eg meningitis and encephalitis
- infections in patients who inject intravenous drugs
- community acquired infections eg cellulitis, pyelonephritis, pneumonia
- systemic fever and rash type illnesses eg chickenpox, shingles, measles
- bone and joint infection not requiring orthopaedic intervention
- suspected endocarditis, in collaboration with cardiology.