April 2015 CALGARY ZONE CLINICAL REFERENCE PULMONARY CENTRAL ACCESS & TRIAGE

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Kristopher Wilkins
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1 April 2015 CALGARY ZONE CLINICAL REFERENCE CENTRAL ACCESS & TRIAGE

2 Introduction Pulmonary consulting services are organized through the Calgary Zone Pulmonary Central Access and Triage (PCAT). Working with Alberta Referral Pathways and Primary Care, PCAT has developed new approaches to improve patient access to appropriate pulmonary care. CALGARY CENTRAL ACCESS & TRIAGE PCAT arranges new patient appointments for general pulmonary clinics and asthma / COPD clinics in the outpatient departments at all four acute care sites in Calgary. PCAT also arranges appointments for patients requiring subspecialty services (bronchiectasis, cough, interstitial lung disease, pulmonary hypertension, neuromuscular, transplant) at specific sites. PCAT will book patients with the first available, appropriate pulmonary consultant based on the reason for referral and geographic location. Referring providers may request an appointment with a specific consultant and / or at a specific site. Referrals will be handled most efficiently and effectively if the PCAT referral form is used and the required supporting documentation is provided. Within two days of receipt, PCAT will confirm receipt of a referral with the referring provider. 2 3

CALGARY CENTRAL ACCESS & TRIAGE PCAT arranges new patient appointments for general pulmonary clinics and asthma / COPD clinics in the outpatient departments at all four acute care sites in Calgary.

3 table of contents *SELECT THE TO MOVE DIRECTLY TO INFORMATION PAGE 7 REFERRAL PROCESS 7 MANDATORY REQUIREMENTS FOR ALL REFERRALS 8 Asthma education 8 Asthma consult 8 Bronchiectasis 8 COPD education 8 COPD consult 8 Chronic cough 9 Dyspnea (shortness of breath) 9 Hemoptysis 9 Hypoxemia 9 Interstitial lung disease (pulmonary fibrosis) 9 Lung cancer (primary) 9 Lung cancer (metastatic) 9 Lung cavity / cyst 10 Lung nodule(s) / mass(es) 10 Lung transplant assessment 10 Lymphadenopathy (hilar / mediastinal) 10 Occupational lung disease 10 Pleural effusion 10 Pleural plaque(s) / thickening 11 Pulmonary embolism 11 Pulmonary fibrosis 11 Pulmonary hypertension 11 Respitory infection 11 Restrictive chest wall disorder (e.g. scoliosis) 11 Sarcoidosis 12 Sleep apnea 12 Smoking cessation 12 Trachea / Upper airway 12 Tuberculosis 12 Vasculitis 12 Vocal cord dysfunction 12 Other 10 Mediastinal mass 10 Mesothelioma 10 Neuromuscular disorders 4 5

cavity / cyst 10 Lung nodule(s) / mass(es) 10 Lung transplant assessment 10 Lymphadenopathy (hilar / mediastinal) 10 Occupational lung disease 10 Pleural effusion 10 Pleural plaque(s) / thickening 11

4 ALL REFERRALS Calgary Zone Pulmonary Central Access & Triage REFERRAL PROCESS For urgent advice from a respirologist, call: RAAPID (South) and ask for the respirologist on-call at one of the four acute care sites or a hospital operator and ask them to page the on-call respirologist FMC (403) PLC (403) RGH (403) SHC (403) ACCESS TARGETS URGENT ROUTINE 3 BUSINESS DAYS 15 BUSINESS DAYS MANDATORY REQUIREMENTS FOR ALL REFERRALS PATIENT DEMOGRAPHICS Patient last name, first name, given names PHN/ULI Date of birth Contact information REQUESTED PROVIDER & LOCATION: Specific provider (name) or first available provider Specific location (FMC / PLC / RGH / SHC) or first available location SUMMARY of known or suspected pulmonary condition of relevant medical history REFERRING PROVIDER Name Address, including city, province, postal code Phone & fax PRAC ID REQUESTED ACTIONS opinion & recommendations only assume care for pulmonary condition perform a procedure (state the procedure) initiate therapy education and training about an underlying condition see list below 6 7

ROUTINE 3 BUSINESS DAYS 15 BUSINESS DAYS MANDATORY REQUIREMENTS FOR ALL REFERRALS PATIENT DEMOGRAPHICS Patient last name, first name, given names PHN/ULI Date of birth Contact information REQUESTED

5 REFERRAL REQUIREMENTS CALGARY ZONE CENTRAL ACCESS & TRIAGE CALGARY ZONE CENTRAL ACCESS & TRIAGE ASTHMA EDUCATION ASTHMA CONSULT BRONCHIECTASIS cancer hemoptysis interstitial lung disease (pulmonary fibrosis) asthma medication used over the past six months DYSPNEA (SHORTNESS OF BREATH) HEMOPTYSIS Active & > 2 TBSPs (30cc) per day asthma COPD Ischemic heart disease Interstitial lung disease (pulmonary fibrosis) pulmonary embolism Patient should be referred directly to an emergency department - do NOT refer to PCAT COPD EDUCATION COPD CONSULT CHRONIC COUGH cancer hemoptysis interstitial lung disease (pulmonary fibrosis) asthma cancer COPD cough duration dyspnea hemoptysis interstitial lung disease (pulmonary fibrosis) weight loss >5 kgs 6 MONTHS Active & < 2 TBSPs (30cc) per day Past history but not active or intermittent HYPOXEMIA INTERSTITIAL LUNG DISEASE ( FIBROSIS) LUNG CANCER (PRIMARY) known or suspected LUNG CANCER (METASTATIC) metastatic cancer to lungs duration / amount (TBSPs or mls per day) If resting O2 sat <85% send patient to the emergency department cancer 12 MONTHS LUNG CAVITY / CYST CT or Chest x-ray 8 9

(pulmonary fibrosis) pulmonary embolism Patient should be referred directly to an emergency department - do NOT refer to PCAT COPD EDUCATION COPD CONSULT CHRONIC COUGH cancer hemoptysis interstitial

6 REFERRAL REQUIREMENTS CALGARY ZONE CENTRAL ACCESS & TRIAGE CALGARY ZONE CENTRAL ACCESS & TRIAGE LUNG NODULE(S) / MASS(ES) EMBOLISM pulmonary embolism LUNG TRANSPLANT ASSESSMENT LYMPHADENOPATHY (HILAR / MEDIASTINAL) MEDIASTINAL MASS MESOTHELIOMA NEUROMUSCULAR DISORDERS (e.g. spinal cord injury / muscular dystrophy) OCCUPATIONAL LUNG DISEASE PLEURAL EFFUSION Occupation-related symptoms cough wheeze dyspnea cancer (metastatic) cytology proven malignant effusion recent (within 2 months) history of pneumonia or empyema CT chest FIBROSIS HYPERTENSION known (based on echo showing RVSP) suspected chronic thromboembolic pulmonary Htn RESPITORY INFECTION bronchitis - acute pneumonia RESTRICTIVE CHEST WALL DISORDER (E.G. SCOLIOSIS) SARCOIDOSIS SEE INTERSTITIAL LUNG DISEASE connective tissue disease cirrhosis congenital heart disease HHT pulmonary embolism anti-coag status & duration of Rx 6 MONTHS echocardiogram echocardiogram 6 MONTHS chest x-ray or CT chest x-ray or CT PLEURAL PLAQUE(S) / THICKENING 10 11

spinal cord injury / muscular dystrophy) OCCUPATIONAL LUNG DISEASE PLEURAL EFFUSION Occupation-related symptoms cough wheeze dyspnea cancer (metastatic) cytology proven malignant effusion recent

7 REFERRAL REQUIREMENTS CALGARY ZONE CENTRAL ACCESS & TRIAGE SLEEP APNEA SMOKING CESSATION TRACHEA / UPPER AIRWAY obstruction fistula mass stenosis TUBERCULOSIS VASCULITIS VOCAL CORD DYSFUNCTION OTHER includes abnormal x-ray imaging REFER PATIENT DIRECTLY TO THE FOOTHILLS SLEEP CENTRE Fax (403) Office (403) REFER PATIENT DIRECTLY TO CALGARY TUBERCULOSIS SERVICES Fax (403) Office (403) Copyright (2015) Alberta Health Services. This material is protected by Canadian and other international copyright laws. All rights reserved. This material is intended for general information only and is provided on an as is, where is basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. This material is not a substitute for the advice of a qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use

291-9185 Office (403) 944-7660 Copyright (2015) Alberta Health Services. This material is protected by Canadian and other international copyright laws. All rights reserved.

CPT codes are for information only; consult your payer organization for reimbursement information.

CPT codes are for information only; consult your payer organization for reimbursement information. Coverage for Spirometry/Oximetry Spirometry is a component of pulmonary function testing (PFTs). PFTs