2.3 Referral for emergency / Initial referral
If the general practitioner confirms, or suspects a diagnosis of AML but cannot confirm it, they must refer the patient to see a specialist (haematologist) to make the diagnosis.
Haematologists must expedite assessments for referred patients. Healthcare providers should facilitate patients’ rapid access to acute leukaemia treatment services. All patients with suspected AML should be evaluated and cared for by a multidisciplinary team with experience in managing AML. Readily accessible contact referral details for leukaemia treatment centres should be available.
Patients should be enabled to make informed decisions about their choice of specialist and health service. General practitioners should make referrals in consultation with the patient after considering the clinical care needed, cost implications (see referral options and informed financial consent), waiting periods, location and facilities, including discussing the patient’s preference for health care through the public or the private system.
Referral for suspected or diagnosed AML should include the following essential information to accurately triage and categorise the level of clinical urgency:
- important psychosocial history and relevant medical history
- family history, current symptoms, medications and allergies
- results of current clinical investigations (imaging and pathology reports)
- results of all prior relevant investigations
- notification if an interpreter service is required.
Many services will reject incomplete referrals, so it is important that referrals comply with all relevant health service criteria.
If access is via online referral, a lack of a hard copy should not delay referral.
The specialist should provide timely communication to the general practitioner about the consultation and should notify the general practitioner if the patient does not attend appointments.
Aboriginal and Torres Strait Islander patients will need a culturally appropriate referral. To view the optimal care pathway for Aboriginal and Torres Strait Islander people and the corresponding quick reference guide, visit the Cancer Australia website. Download the consumer resources – Checking for cancer and Cancer from the Cancer Australia website.
- Patients with sepsis, bleeding or severe symptoms should be regarded as a medical emergency and be referred immediately to an appropriate emergency facility without necessarily waiting for results of laboratory tests (same day). All emergency facilities should have existing arrangements to receive urgent haematological advice.
- Patients with suspected AML who present to an emergency department should be triaged as a medical emergency initially and discussed immediately with a clinical haematology service and/or transferred immediately to a specialist centre. This particularly applies to patients with suspected APL.
- Patients with a laboratory diagnosis of possible AML should be referred for an urgent assessment by a haematologist at an appropriate facility within 24 hours. A deferred assessment should only be done after a discussion between the referring doctor and the responsible haematologist.
