Non-healing wounds and ulcers Referral Access Criteria

• Sepsis or septic shock (based on 2 or more of the following: fever, tachypnoea, tachycardia, hypotension, lactate >2)
• Suspected deep tissue infection (presence of bullae, necrosis, or subcutaneous emphysema)
• Suspected necrotising fasciitis
• Upper limb cellulitis with suspicion of sepsis or septic shock, or not responding to oral antibiotics
• Infectious flexor tenosynovitis
• Neurovascular compromise
• Acutely exposed fixation plates (e.g. post-fall)
• Fracture non-union requiring flap coverage

• Skin threatening injury e.g. large haematoma, large skin tear
• Soft tissue loss greater than 5cm2

• Chronic wounds and ulcers that are both of the following:
  
  • not primarily of vascular nature (e.g. lymphoedema, not due to venous or arterial insufficiency) AND
  • has not shown significant progress toward healing within 4 weeks
• Examples include pressure sores, non-healing skin tears, and suspected malignancy

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reasons). This information is required to inform accurate and timely triage.

If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset and duration of symptoms and change over time
• Degree of functional impairment (e.g. impact on mobility/exercise tolerance/ADLs/ability to work/quality of life)
• Current medication list
• Any known allergies
• Details of smoking and/or vaping (containing nicotine) status (not mandatory for malignancies)
• Details of current and previous treatment and outcome

• BMI
• Measurements of the ulcer and associated features e.g. shape, colour, inflammation, oozing, change in sensation, bleeding

•  Punch biopsy or excisional biopsy from the active margin

• Advise whether or not your patient is taking any anti-platelets or anti-coagulants
  
  • if so, state the indication

• Photograph of the wound/ulcer

• HbA1c

Category 1

Appointment within 30 days

• Suspected malignancy
• Threat to function of limb or exposed fixation plates

Category 2

Appointment within 90 days

• Delayed presentation soft tissue laceration/s without systemic features or rapidly progressing infection responsive to antibiotics
• Contaminated (swab positive and not frankly infected) non-healing wound present for >4 weeks
• Limitation to weight bearing ability e.g. ulceration of sole, non-union of fracture requiring flap coverage
• Ulcers without progression of healing (e.g. sacral, ischial or lower limb)

Category 3

Appointment within 365 days

• No defined category 3 criteria

• Burns
  
  • refer to State Burns Service
  • see Clinician Assist WA: Specialised Burns Management Requests
• Chest and abdomen soft tissue infections
  
  • refer to General Surgery
  • see Clinician Assist WA: General Surgery Advice
• Lower limb soft tissue infections without ulceration, including cellulitis of the lower limb
  
  • refer to General Medicine, Infectious Diseases and/or Silver Chain Hospital at the Home
    
    • see Clinician Assist WA: Cellulitis in Adults
• Chronic wounds and ulcers that are primarily of vascular nature
  
  • refer to Vascular
• Non-infected foot ulcer in a person with diabetes, not decreased in size by 50% after 2 to 4 weeks standard care, refer to Multidisciplinary Foot Ulcer Clinic
  
  • see Clinician Assist WA: Multidisciplinary Foot Ulcer Team

• A chronic wound is one that has failed to progress through the phases of healing in an orderly and timely fashion and has shown no significant progress toward healing in 30 days. Factors contributing to the chronicity of the wound may include:
  
  • increased bacterial load
  • medications
  • systemic issues such as poorly controlled diabetes, peripheral oedema, poor circulation, malnutrition
  • inappropriate frequency/management/treatment regime
  • chemotherapy
  • radiation therapy.
• For wound dehiscence, contact the surgeon who performed the original procedure for assessment and management where possible
• Spinal pressure injuries:
  
  • For spinal pressure injury advice
    
    • contact Spinal Outreach Service, OR
  • Refer to State Rehabilitation Service Spinal Pressure Injury clinic, OR
    
    • NB: The service is unable to provide wound dressing or surgical advice.
  • For ongoing wound care recommendations and management, refer to local community or hospital wound care providers/nurse specialists, OR
  • For surgical advice refer directly to local hospital surgical service
• For guidance on assessment of wounds and ulcers, see RACGP: Ulcer Dressings and Management (2014)
• For information on skin biopsies, see RACGP: Improving diagnostic accuracy of skin biopsies (2018)
• See MBS item: 30071 or MBS item: 30072 for information on the Medicare Benefits Schedule on the mandatory investigations (diagnostic biopsy)