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Acute Medicine

Access Criteria

Standard Operating Procedures for Acute Patient Care

Appendix 1:  Services for Consult per Diagnosis/Presenting Problem

  1. This table guides referral to specialties based on diagnosis or most likely diagnosis.  It is not exhaustive, and does not override clinical judgement or other clinical agreements.

  2. Site dependent differences for admissions do exist.
    • Tauranga - patients will be admitted under the relevant sub-specialty.
    • Whakatane - Dental, ENT, Ophthalmology, Plastics, Cardiology and Urology patients will be admitted under the General Surgery or Medicine Team and a discussion with the relevant specialty team must occur by 0900 hours the next day.
Diagnosis / Presenting Problem Modifying Factors Service

Abdominal Pain

Pyelonephritis or UTI

General Medicine

Suspected renal or obstructing ureteric stone

Urology /at Whk GS with F/U consult

All other patients (without an obvious gynaecological cause)

General Surgery

Alcohol withdrawal

If severe acute symptoms

General Medicine


Non orthopaedic causes

General Medicine

Gastrointestinal Bleeding

Gastrointestinal Bleeding from Upper GIT with or without medical Co-morbidities

General Medicine admission with Surgical consultation

Gastrointestinal Bleeding from Lower GIT

General Surgery

If suspected occult GIT blood loss or unknown cause and requiring admission for management

General Medicine

Abdominal Aortic  Aneurysm (AAA) / Dissection

Suspected or proven abdominal aortic aneurysm dissection.

Surgery / Vascular

Thoracic Aortic Dissection

Suspected or proven non-traumatic thoracic aortic dissection.

Distal to left subclavian artery ("Type B") for medical management

Type A General Surgery

Type B Medicine / Cardiology

Back pain

Related to trauma, infection or possible disc pathology.


Osteoporotic collapse


Chronic Lower Back pain requiring admission for pain control and physio (i.e. failed trial of adequate pain medications and ambulation)


Signs of cord compression


Secondary to malignancy unless there are features of cord compression.

General Medicine if patient not known to another Service

Cellulitis / Gangrene

Cellulitis over a joint or evidence/suspicion of osteomyelitis or septic arthritis

Associated with wound (no joint / osteomyelitis involvement)


General Surgery

Diabetic foot ulcer with cellulitis or suspected necrotising fasciitis

General Surgery

Infection requiring surgical debridement or amputation

General Surgery

Facial or odontogenic

Dental/or at Whk GS with F/U consult

Periorbital or Orbital

Ophthalmology /or at Whk GS with F/U consult

Perineum involved

General Surgery

All others

General Medicine



General Surgery


Medical causes e.g. HT / coagulopathy / platelet disorders etc

General Medicine

Local nasal pathology e.g. trauma / tumour etc

ENT (in WHK - general surgery)

Uncontrollable bleeding (any cause)

Consult ENT for assistance (in WHK - general surgery)

Facial Fractures

Requiring Admission

Maxillo-facial / or at Whk GS with F/U consult

With dental Issues

Foreign Body ENT


ENT outpatients (both sites)


ENT (in WHK - general surgery)

Hepatitis / Liver Failure



Hypertensive Emergency


General Medicine

Ischemic Limb


General Surgery/Vascular

Ischemic Colitis


General Surgery

Oncology Problem

Patient currently known to the oncology service and with a related problem

Oncology /or at Whk GS with F/U consult(working hours) otherwise General Medical

All other oncology related problems

General Medicine


Of surgical nature (especially if adult equivalent problem)

General Surgery with Paediatrics consult

Of medical nature



Obstructive cause (e.g., gallstones), Alcoholic

General Surgery

Post ERCP, discuss with consultant who performed procedure

General Surgery

Psychosis / Delirium

Presumptive organic cause requiring ongoing medical treatment

General Medicine

Exacerbation of chronic psychiatric condition and no complicating organic causes identified


No organic cause identified, no previous history



Obstructing ureteric stone

Urology/at Whk GS with F/U consult

Pregnant Patient


All other UTIs requiring admission

General Medicine

Renal Failure, Acute

Due to obstructive uropathy including urinary retention


Underlying surgical cause 

General Surgery

All others


Sore Throat

+ Quinsy (Peritonsillar Abscess)

ENT in consulting working hours, general medicine outside working hours with ENT consult next morning / at Whk Med with F/U

- Quinsy

General Medicine


Ischemic Stroke or Haemorrhagic stroke for conservative management

Stroke Team

Transient Ischemic Attack (TIA)

Refer to TIA protocol

Syncope / Seizures


General Medicine


Thoracic injury (penetrating, blunt) or abdominal injury (penetrating, blunt) requiring admission

General Surgery

Head Injury requiring observation or transfer

General Surgery

Extremity fracture or ligamentous injury requiring surgical consult


Pelvic fracture of any type caused by significant trauma in any age group


Facial or mandibular fractures requiring surgical consults

Maxillo-facial/ENT/or at Whk GS with F/U consult

Vascular injury

General Surgery

Intracranial Haemorrhage not requiring neurosurgical intervention

General Surgery

Vertebral Fracture


Spinal Injury with neurological compromise