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Orthopedic Centralized Access - Facilitated Access to Specialized Treatment (FAST)   at
Calgary Zone and Area
Central Access Healthcare Service
Specialty: Orthopaedic Surgery
Estimated time to routine appointment: Not Available
Alberta Health Services - Calgary Zone
CENTRAL ACCESS SERVICES
Referrals for Orthopedic in the Calgary Zone are accepted through this Facilitated Access to Specialized Treatment (FAST) central access and intake program. Referring providers can choose a next-available surgeon with the shortest waitlist; a specific surgeon, clinic, or site; or an out-of-zone provider. FAST receives the surgical referrals, reviews them for completeness and duplication, and then sends them to appropriate surgeons for triage and booking.
Referrals for Orthopedic in the Calgary Zone are accepted through this Facilitated Access to Specialized Treatment (FAST) central access and intake program. Referring providers can choose a next-available surgeon with the shortest waitlist; a specific surgeon, clinic, or site; or an out-of-zone provider. FAST receives the surgical referrals, reviews them for completeness and duplication, and then sends them to appropriate surgeons for triage and booking.
ELIGIBILITY REQUIREMENTS
Review reasons for referral table below for eligibility requirements.
Review reasons for referral table below for eligibility requirements.
Referral instructions for primary care, community care, private
providers etc. who do not send referrals via Connect Care.
REFERRAL PROCESS - FOR NON-CONNECT CARE USERS
1. Complete the referral form or a referral letter stating the reason for referral.
2. Attach all mandatory information to the referral (see Provincial Adult Orthopedic & Spine Referral Pathway)
3. Fax completed referral to Calgary Zone FAST using the contact informationon this profile.
You can also submit referrals through Alberta Netcare eReferral by following these instructions.

A referral requires confirmation your patient does not qualify for expedited surgery through Workers’
Compensation Board (WCB).

For spine assessments, send referral to specialist as per local zone processes.
1. Complete the referral form or a referral letter stating the reason for referral.
2. Attach all mandatory information to the referral (see Provincial Adult Orthopedic & Spine Referral Pathway)
3. Fax completed referral to Calgary Zone FAST using the contact informationon this profile.
You can also submit referrals through Alberta Netcare eReferral by following these instructions.

A referral requires confirmation your patient does not qualify for expedited surgery through Workers’
Compensation Board (WCB).

For spine assessments, send referral to specialist as per local zone processes.
REFERRAL PROCESS - FOR CONNECT CARE USERS
An Outgoing Referral is required for this service.
Change the referral class to “Outgoing Referral” on the Ambulatory Order and complete order.
Outgoing orders are not sent electronically and require processing in workqueue 5.

A referral requires confirmation your patient does not qualify for expedited surgery through Workers’
Compensation Board (WCB).

For spine assessments, send referral to specialist as per local zone processes.
An Outgoing Referral is required for this service.
Change the referral class to “Outgoing Referral” on the Ambulatory Order and complete order.
Outgoing orders are not sent electronically and require processing in workqueue 5.

A referral requires confirmation your patient does not qualify for expedited surgery through Workers’
Compensation Board (WCB).

For spine assessments, send referral to specialist as per local zone processes.
COMMUNICATION PROCESS
  • Referral receipt to referring source within 7 days.
ADDITIONAL SERVICE DETAILS
Urgent referral: Patient may need to be seen immediately. Patients with conditions that require same day intervention and/or diagnostics but not hospitalizations and not life threatening.
Call surgeon-on-call via RAAPID South at 1-800-661-1700 for:
  • Acute fractures including all fractures within 4 weeks of injury
  • Acute tendon ruptures and torn ligaments
  • Dislocation
  • Metastatic bone tumors including impending pathologic fractures,
  • Acute pathologic fractures.
For suspected primary or locally aggressive bone tumors, refer to Orthopedic Oncology (except in Lethbridge – Call orthopedic surgeon on call for Wrist).
If the patient is already under the care of an orthopedic surgeon for this injury, please contact them. Please refer to specific process for acute injuries below.

For emergent referral: Patient needs to be seen immediately.
Call RAAPID South at 1-800-661-1700 or send to Emergency Department via 911 as appropriate for:
  • Open fractures and / or fractures potentially requiring acute operative treatment (bimalleolar ankle #, markedly displaced wrist #, hip #, long bone #s, comminuted proximal humerus #, etc.);
  • Suspected septic joints and Orthopedic infections;
  • Irreducible acute joint dislocations;
  • Compartment syndrome (acute);
  • Cauda equina or progressive neurologic deficit after injury.
Learn more about FAST at ahs.ca/FAST.
Urgent referral: Patient may need to be seen immediately. Patients with conditions that require same day intervention and/or diagnostics but not hospitalizations and not life threatening.
Call surgeon-on-call via RAAPID South at 1-800-661-1700 for:
  • Acute fractures including all fractures within 4 weeks of injury
  • Acute tendon ruptures and torn ligaments
  • Dislocation
  • Metastatic bone tumors including impending pathologic fractures,
  • Acute pathologic fractures.
For suspected primary or locally aggressive bone tumors, refer to Orthopedic Oncology (except in Lethbridge – Call orthopedic surgeon on call for Wrist).
If the patient is already under the care of an orthopedic surgeon for this injury, please contact them. Please refer to specific process for acute injuries below.

For emergent referral: Patient needs to be seen immediately.
Call RAAPID South at 1-800-661-1700 or send to Emergency Department via 911 as appropriate for:
  • Open fractures and / or fractures potentially requiring acute operative treatment (bimalleolar ankle #, markedly displaced wrist #, hip #, long bone #s, comminuted proximal humerus #, etc.);
  • Suspected septic joints and Orthopedic infections;
  • Irreducible acute joint dislocations;
  • Compartment syndrome (acute);
  • Cauda equina or progressive neurologic deficit after injury.
Learn more about FAST at ahs.ca/FAST.
 
CENTRAL ACCESS REFERRAL PHONE
1-833-553-3278 ext 4
CENTRAL ACCESS REFERRAL FAX
1-833-627-7023
REFERRAL FORMS
PATHWAYS
LINKED SPECIALISTS
CLICK + TO VIEW REFERRAL GUIDELINES
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Routine Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
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Ankle and/or foot joint pain
  • Bilateral, weightbearing views foot and ankle.
  • Weight bearing Foot - Routine: AP Axial and Lateral.
  • Weight bearing Ankle - Routine: AP, AP Oblique 15°-20° medial rotation, lateral.
  • If the patient has diabetes, please include HbA1c.
 
< 3 months of referral
PAIN - FOOT & ANKLE
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
+-
Ankle instability
  • Bilateral, weightbearing views foot and ankle.
  • Weight bearing Foot - Routine: AP Axial and Lateral.
  • Weight bearing Ankle - Routine: AP, AP Oblique 15°-20° medial rotation, lateral.
  • If the patient has diabetes, please include HbA1c.
 
< 3 months of referral
INSTABILITY - ANKLE
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
+-
Arthritis of elbow
X-rays of the affected elbow: AP, Lateral.
 
< 12 months of referral
ARTHRITIS - ELBOW 
  • Send referral to Zone FAST Team
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
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Arthritis of hand
  • X-ray of the affected area.
  • Specify previous treatments (such as injections).
 
< 12 months of referral
ARTHRITIS OF HAND
  • Including thumb and fingers
  • i.e. osteoarthritis
Send referral to Calgary Zone FAST Team
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.

Additional imaging not required. Further tests will be obtained by the specialist if necessary.
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Arthritis of hip
Routine x-rays: weight bearing AP pelvis centred at pubis, AP Hip of proximal half of affected femur, Lateral view (Lauenstein) of proximal half of affected femur.
 
< 6 months of referral
ARTHRITIS - HIP Includes: Osteoarthritis, rheumatoid arthritis, inflammatory arthritis
  • Send referral to Calgary Zone FAST Team.
Choosing Wisely recommends not ordering a hip MRI whenx-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment.
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Arthritis of knee
  • X-ray of the affected knee: Weightbearing* - Knee Routine: Standing PA with Knees Flexed 45° (Rosenburg), Lateral, Skyline and Bilateral standing AP/PA views.
*If patient is unable to weight bear AP/Lateral x rays and 2 oblique views (Trauma Series).
  • Include within the referral letter:
    • Description of symptom onset and duration
    • Functional status limitations (example: impact on sleep, work, activities of daily living)
    • Treatments initiated and responses.
 
< 6 months of referral
ARTHRITIS - KNEE Includes: Osteoarthritis, inflammatory arthropathy
  • Send referral to Zone FAST Team.
  • Choosing Wisely recommends not ordering a knee MRI when weight-bearing x-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment.
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Arthritis of wrist
X-ray of the affected area.
 
< 12 months of referral
Specify previous treatments (such as injections).
 
< 12 months of referral
  • Send referral to Calgary Zone FAST Team or Plastic Surgery
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
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Avascular necrosis of hip
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
AVASCULAR NECROSIS (AVN) (WITHOUT OSTEOARTHRITIS) - HIP
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • For a patient with normal x-rays and hip pain - MRI is not required.
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Back pain
  • Upright/standing thoracic and/or lumbar spine x-ray strongly suggested.
  • MRI may be considered for patients with pain refractile to exhaustive medical therapy with pain suggestive of discogenic origin.
 
< 12 months of referral
BACK PAIN (WITHOUT NEUROLOGICAL SYMPTOMS OR REFERRED PAIN)

Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information.
  • Refer to CLINICAL PATHWAY: SPINE LOW BACK ASSESSMENT
  • If available, non-surgical specialist assessment should be considered prior to referral (such as physiatry, sport medicine).
  • For insufficiency fractures - Consider referral to a specialist only if insufficiency fracture with pain not responsive to medical therapy or with progressive deformity.
  • Oblique and flexion/extension x-rays are not recommended.
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Bone deformity of hip
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
BONE DEFORMITY OTHER - HIP Includes: Length inequality, rotational problem
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
  • For a patient with normal x-rays and hip pain - MRI is not required
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Carpal tunnel syndrome
Include within the referral letter (Refer to clinical pathway for additional support):
  • Description of symptom onset and duration
  • Specify if atrophy or weakness present, as this impacts triage.
  • Functional status limitations
  • Treatments initiated and responses.
 
N/A
CARPAL TUNNEL SYNDROME
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.
  • Electrodiagnostic studies should be ordered concurrently if atrophy/weakness present (i.e. severe carpal tunnel syndrome)
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Chronic pain of soft tissue of elbow region
  • X-rays of the affected elbow: AP, Lateral
  • Electrodiagnostic study (ordered) if associated with hand numbness.
 
< 12 months of referral
CHRONIC SOFT TISSUE PAIN - ELBOW 
Includes: Lateral and medial epicondylosis
  • Send referral to Calgary Zone FAST Team if pain has persisted for over 1 year.
  • Non-surgical specialist assessment could be considered prior to referral (advanced practice physiotherapist, physiatrist, sport medicine).
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • For Lateral and Medial Epicondylosis: Please avoid cortisone injection and refer the patient for physiotherapy. Please consider referral to Zone FAST Team only if the patient has exhausted at least 6 months of nonoperative management with no significant response. For more information, you may look at "Five things to know about lateral epicondylosis" https://www.cmaj.ca/content/194/7/E257
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Congenital hip dysplasia
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
CONGENITAL HIP DYSPLASIA (without osteoarthritis)
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • For a patient with normal x-rays and hip pain - MRI is not required.
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Cyst
  • Trial of 3 aspirations (OR reason why unable/inappropriate to aspirate)
  • X-ray of affected joint
  • For cystic masses, order ultrasound when uncertain whether cystic or solid mass
 
N/A
CYST of HAND or WRIST 
Includes simple cystic mass (i.e. ganglion cyst)
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Deformity of foot
  • Bilateral, weightbearing views foot and ankle.
  • Weight bearing Foot - Routine: AP Axial and Lateral.
  • Weight bearing Ankle - Routine: AP, AP Oblique 15°-20° medial rotation, lateral.
  • If the patient has diabetes, please include HbA1c.
 
< 3 months of referral
DEFORMITY - FOOT
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
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Deformity of wrist and/or hand
X-ray of the affected area.
 
< 12 months of referral
DEFORMITY - HAND & WRIST Includes:Tendon related deformity (mallet finger,
jersey finger, boutonniere’s).

Send referral to Calgary Zone FAST Team
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone
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Disorder of ligament of hand
X-ray of the affected area
 
< 12 months of referral
LIGAMENT PATHOLOGIES - HAND Includes: Chronic rupture of ulnar collateral ligament of thumb, Chronic tear of ligament of finger or thumb
  • > 4 weeks, send referral to Calgary Zone FAST Team
  • Please consider printing this article for your patient to bring with them to complete the bilateral clenched fist view x-ray: “The “Clenched Pencil” View: A Modified Clenched Fist Scapholunate Stress View, JHS 2003.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.
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Disorder of ligament of wrist
  • X-ray of the affected area
  • Consider For Scapholunate - Please also order bilateral x-ray clenched fist view.
 
< 12 months of referral
LIGAMENT PATHOLOGIES - WRIST Includes: Scapholunate, triangular fibrocartilage complex (TFCC) / distal radial ulnar joint (DRUJ) instability

  • > 4 weeks, send referral to Calgary Zone FAST Team
  • Please consider printing this article for your patient to bring with them to complete the bilateral clenched fist view x-ray: “The “Clenched Pencil” View: A Modified Clenched Fist Scapholunate Stress View, JHS 2003.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone
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Disorder of meninges
N/A
 
N/A
INTRADURAL PATHOLOGIES
Includes: Intradural tumors, tethered spinal cord, chiari malformation, intradural anatomic derangement, vascular malformation

This reason for referral is seen by Spine Neurosurgery and not Orthopedics.

Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information.
  • For patients with acute neurological symptoms, please consult the Neurosurgeon on call in Calgary or Edmonton.
  • Tumours include: Schwannoma, peripheral nerve sheath tumor, meningioma, ependymoma, glioma.
  • Intradural structural derangements including arachnoid cysts, spinal cord herniation.
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Dupuytren's disease of palm
Please specify degree of contracture
  • Tabletop Test Result: Operative intervention is primarily offered to patients who are unable to place their hand flat on the table, or to those with significant tenderness.
  • Presence of tender nodules, if present.
  • Presence of work/life limitations, if present.
 
NA
DUPUYTREN'S CONTRACTURE
Fixed progressive flexion contracture of palmar fascia.
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Elbow mass
N/A
 
N/A
MASS (TUMOR OR LUMP) - ELBOW
  • For suspected or proven malignancies, aggressive tumors (sarcoma), send referrals to Orthopedic Oncology in Calgary.
  • For all other concerns send to Zone FAST Team
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Entrapment neuropathy of elbow
  • X-rays of the affected elbow: AP, Lateral.
  • Electrodiagnostic study (ordered).
  • Please specify if wasting and weakness are present.
 
< 12 months of referral
ENTRAPMENT NEUROPATHIES OF UPPER LIMB - ELBOW Includes: Median neuropathy, radial
neuropathy, ulnar neuropathy
  • Send referral to Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
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Femoral acetabular impingement
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein)
 
< 6 months of referral
HIP IMPINGEMENT (Femoral acetabular impingement)
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • For a patient with normal x-rays and hip pain - MRI is not required.
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Fracture
X-ray of affected body part or joint.
 
For anything > 4 weeks
FRACTURE (> 4 WEEKS)
Includes: Mal-union, non-union, fractures treated (surgically or non-surgically) outside of patient’s Zone but requiring treatment or follow up.
  • > 4 weeks and patient is unattached to a surgeon, send referral to Calgary Zone FAST Team.
  • Note: If the patient is already under the care of an Orthopedic surgeon for this injury, please contact them.
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Hand pain
  • X-ray of the affected area.
  • Specify location of pain (thumb, metacarpal, phalangeal) and chronicity of pain.
 
< 12 months of referral
HAND PAIN
Send referral to Calgary Zone FAST Team
**Please note a collaborative program exists between Orthopedic and
Plastic Surgery in the Calgary Zone.

If pain is related to another reason for referral, please order the appropriate investigations.
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Hip pain
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein)
 
< 6 months of referral
PAIN (WITHOUT OSTEOARTHRITIS) - HIP
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • For a patient with normal x-rays and hip pain - MRI is not required.
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Instability of knee
  • X-ray of the affected knee: Weightbearing* - Knee Routine: Standing PA with Knees Flexed 45° (Rosenburg), Lateral, Skyline and Bilateral standing AP/PA views.
*If patient is unable to weight bear AP/Lateral x rays and 2 oblique views (Trauma Series).
  • Include within the referral letter:
    • Description of symptom onset and duration
    • Functional status limitations (example: impact on sleep, work, activities of daily living)
    • Treatments initiated and responses.
 
< 6 months of referral
INSTABILITY - KNEE
  • Refer to CLINICAL PATHWAY: SOFT TISSUE KNEE ASSESSMENT 
  • Send referral to Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
  • Knee ultrasound is not generally recommended unless trying to confirm a tendon rupture.
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Knee pain
  • X-ray of the affected knee: Weightbearing* - Knee Routine: Standing PA with Knees Flexed 45° (Rosenburg), Lateral, Skyline and Bilateral standing AP/PA views.
*If patient is unable to weight bear AP/Lateral x rays and 2 oblique views (Trauma Series).
  • Include within the referral letter:
    • Description of symptom onset and duration
    • Functional status limitations (example: impact on sleep, work, activities of daily living)
    • Treatments initiated and responses.
 
< 6 months of referral
PAIN (WITHOUT OSTEOARTHRITIS) - KNEE
  • Refer to CLINICAL PATHWAY: SOFT TISSUE KNEE ASSESSMENT 
  • Send referral to Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary
  • Knee ultrasound is not generally recommended unless trying to confirm a tendon rupture.
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Mass of wrist and/or hand
  • Imaging results demonstrating solid mass
  • MRI ordered
 
N/A
MASS of HAND or WRIST - SUSPECTED BENIGN (solid mass with significant symptoms)
  • Refer to Clinical Pathway: Hand and Wrist Soft Tissue Mass 
  • Send referral to Zone FAST Team.
  • Significant symptoms include: severe pain, functional impairment impacting activities of daily living, spontaneous discharge of fluid, significant nail deformity, and numbness/tingling
  • Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Edmonton and Calgary Zones**
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Mechanical symptom of knee
  • X-ray of the affected knee: Weightbearing* - Knee Routine: Standing PA with Knees Flexed 45° (Rosenburg), Lateral, Skyline and Bilateral standing AP/PA views.
*If patient is unable to weight bear AP/Lateral x rays and 2 oblique views (Trauma Series).
  • Include within the referral letter:
    • Description of symptom onset and duration
    • Functional status limitations (example: impact on sleep, work, activities of daily living)
    • Treatments initiated and responses.
 
< 6 months of referral
MECHANICAL KNEE SYMPTOMS Includes: Locking, catching, swelling, effusion
  • Refer to CLINICAL PATHWAY: SOFT TISSUE KNEE ASSESSMENT 
  • Send referral to Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
  • Knee ultrasound is not generally recommended unless trying to confirm a tendon rupture.
+-
Median nerve entrapment
  • Electrodiagnostic study results required as results impacts triage decisions.
  • Please specify if wasting and weakness are present
 
<12 months of referral
MEDIAN NERVE ENTRAPMENT Other than carpal tunnel syndrome. Includes: Pronator Syndrome, Lacertus Syndrome.
  • Send referral to Calgary Zone FAST Team 
*Please note a collaborative program exists between Orthopedic andPlastic Surgery in the Calgary Zone.
  • For traumatic nerve injuries refer to Plastic Surgery, SHC Hand Program or Peripheral Nerve Injury Clinic.
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Myelopathy
  • Patients who have had previous spinal surgery: Gadolinium-enhanced scans are suggested.
  • Referrals intended for direct surgical consideration (or patients for named surgeon/neurosurgical spine triage and assessment clinic): MRI Required prior to referral.
  • Referrals intended for Spine Assessment and Management: MRI not required prior to referral. Advanced imaging will be ordered by specialty as required.
  • Include description of neurological signs and symptoms that are present.
  • Include reports of previous interventional procedures, x-rays and relevant surgical interventions.
 
< 12 months of referral
MYELOPATHY (CERVICAL OR THORACIC)
Includes: Symptoms of upper motor neuron dysfunction including, but not limited to, numbness, balance disturbance, bladder dysfunction, loss of dexterity with concordant spinal cord compression

Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information.
  • Oblique and flexion/extension x- rays are not recommended.
  • Electrodiagnostic testing not recommended unless needed to rule out alternate diagnosis.
  • CT scans are not recommended for diagnosis of nerve root or cauda equina compression unless MRI scan is contraindicated for implants such as pacemakers
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Neck pain
Upright/standing cervical spine x-ray strongly suggested
 
< 12 months of referral
NECK PAIN (WITHOUTNEUROLOGICAL SYMPTOMS OR REFERRED PAIN)
Includes: Benign tumors

Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information.
  • If available, non-surgical specialist assessment should be considered prior to referral (such as physiatry, sport medicine).
  • Oblique and flexion/extension x-rays are not recommended
+-
Neurogenic claudication
  • Patients who have had previous spinal surgery: Gadolinium-enhanced scans are suggested.
  • Referrals intended for direct surgical consideration (or patients for named surgeon/neurosurgical spine triage and assessment clinic): MRI Required prior to referral.
  • Referrals intended for Spine Assessment and Management: MRI not required prior to referral. Advanced imaging will be ordered by specialty as required.
  • Include description of neurological signs and symptoms that are present.
  • Include reports of previous interventional procedures, x-rays and relevant surgical interventions.
 
< 12 months of referral
NEUROGENIC CLAUDICATION Includes: Lumbar, lower extremity numbness, pain or weakness associated
with walking or standing

Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information.
  • Refer to CLINICAL PATHWAY: SPINE LOW BACK ASSESSMENT
  • Oblique and flexion/extension x-rays are not recommended.
  • Electrodiagnostic testing not recommended unless needed to rule out alternate diagnosis.
  • CT scans are not recommended for diagnosis of nerve root or cauda equina compression unless MRI scan is contraindicated for implants such as pacemakers.
+-
Non-degenerative elbow joint pathology
  • X-rays of the affected elbow: AP, Lateral.
  • CT scan(ordered).
  • Please specify locking if referring for medial and lateral elbow pain.
 
< 12 months of referral
NON-DEGENERATIVE JOINT PATHOLOGY (NON-ARTHRITIC) - ELBOW
Includes: Loose bodies, osteochondritis
dissecans (OCD)
  • Send referral to Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary.
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Olecranon bursitis
X-rays of the affected elbow: AP, Lateral
 
< 12 months of referral
OLECRANON BURSITIS Includes: Gouty tophi
  • Consider a referral to Zone FAST Team if bursitis has not resolved with 1 year of conservative management.
  • For Gouty Tophi, always maximize medical gout management before considering a referral to Calgary Zone FAST Team.
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Primary malignant neoplasm of hand
Urgent MRU results
 
N/A
MASS of HAND or WRIST - SUSPECTED MALIGNANT
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Radial nerve entrapment
  • Electrodiagnostic study required as results impact triage decisions
  • Please specify if wasting and weakness are present.
 
< 12 months of referral
RADIAL NERVE ENTRAPMENT Includes: Radial Tunnel, PIN Compression, Wartenberg’s Syndrome
  • Send referral to Zone FAST Team.
**Please note a collaborative program exists between Orthopedic and
Plastic Surgery in the Calgary Zone.
  • For traumatic nerve injuries refer to Plastic Surgery, SHC Hand Program or
    Peripheral Nerve Injury Clinic.
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Radiculopathy
  • Patients who have had previous spinal surgery: Gadolinium-enhanced scans are suggested.
  • Referrals intended for direct surgical consideration (or patients for named surgeon/neurosurgical spine triage and assessment clinic): MRI Required prior to referral.
  • Referrals intended for Spine Assessment and Management: MRI not required prior to referral. Advanced imaging will be ordered by specialty as required.
  • Include description of neurological signs and symptoms that are present.
  • Include reports of previous interventional procedures, x-rays and relevant surgical interventions.
 
< 12 months of referral
RADICULOPATHY (Cervical or Lumbar)
Symptoms of pain, weakness or numbness attributable to one or several nerve roots
  • Refer to CLINICAL PATHWAY: SPINE LOW BACK ASSESSMENT 
  • Send referral to specialist as per local zone processes. Refer to Alberta Referral Directory for referral information
  • Oblique and flexion/extension x-rays are not recommended
  • Electrodiagnostic testing not recommended unless needed to rule out alternate diagnosis.
  • CT scans are not recommended for diagnosis of nerve root or cauda equina compression unless MRI scan is contraindicated for implants such as pacemakers
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Residual childhood hip disorder
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
Hip Disorder Residual Childhood
Includes: Perthes and slipped capital femoral epiphysis (SCFE)
  • Send referral to Calgary Zone FAST Team
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
  • For a patient with normal x-rays and hip pain - MRI is not required.
+-
Retained orthopedic hardware in hip
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
RETAINED ORTHOPEDIC HARDWARE - HIP
  • Send referral to Calgary Zone FAST Team (direct to original surgeon if available)
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
  • For a patient with normal x-rays and hip pain - MRI is not required.
+-
Retained orthopedic hardware in knee
  • X-ray of the affected knee: Weightbearing* - Knee Routine: Standing PA with Knees Flexed 45° (Rosenburg), Lateral, Skyline and Bilateral standing AP/PA views.
*If patient is unable to weight bear AP/Lateral x rays and 2 oblique views (Trauma Series).
  • Include within the referral letter:
    • Description of symptom onset and duration
    • Functional status limitations (example: impact on sleep, work, activities of daily living)
    • Treatments initiated and responses.
 
< 6 months of referral
RETAINED ORTHOPEDIC HARDWARE - KNEE
  • Send referral to Calgary Zone FAST Team (direct to original surgeon if available)
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary
  • Knee ultrasound is not generally recommended unless trying to confirm a tendon rupture.
+-
Retained orthopedic hardware in shoulder
X-rays of the affected shoulder:
  • Shoulder Girdle: AP (with external rotation), AP Oblique (Glenoid), PA/AP Oblique (Scapular Y), Axial
 
< 6 months of referral
RETAINED ORTHOPEDIC HARDWARE - SHOULDER
  • Send referral to Calgary Zone FAST Team (direct to original surgeon if available)
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary
+-
Rheumatoid hand deformity
N/A
 
N/A
RHEUMATOID HAND 
  • Refer to Rheumatology in order to medically optimize prior to surgery use Alberta Referral Directory to find out referral information.
  • For surgical referral:Send referral to Zone FAST Team
+-
Shoulder joint instability
X-rays of the affected shoulder:
  • Shoulder Girdle: AP (with external rotation), AP Oblique (Glenoid), PA/AP Oblique (Scapular Y), Axial
  • AND AP Axial (Stryker Notch), Inferosuperior Axial (West Point).
 
< 6 months of referral
INSTABILITY - SHOULDER
+-
Shoulder joint stiffness
X-rays of the affected shoulder:
  • Shoulder Girdle: AP (with external rotation), AP Oblique (Glenoid), PA/AP Oblique (Scapular Y), Axial.
 
< 6 months of referral
STIFFNESS - SHOULDER
+-
Shoulder pain
X-rays of the affected shoulder:
  • Shoulder Girdle: AP (with external rotation), AP Oblique (Glenoid), PA/AP Oblique (Scapular Y), Axial.
 
< 6 months of referral
PAIN - SHOULDER
+-
Spinal deformity
  • Scoliosis AP/lateral x-ray (must be completed in an AHS facility).
  • If neurological symptoms (claudication, radiculopathy, myelopathy) are also present, MRI is strongly recommended.
 
< 12 months of referral
SPINAL DEFORMITY
Includes: Scoliosis
+-
Suspected rupture of tendon
X-ray of affected body part or joint
 
For anything > 4 weeks
SUSPECTED TENDON RUPTURE (> 4 WEEKS)
Includes: Distal biceps tendon, triceps tendon, quadriceps tendon, achilles tendon, proximal hamstring, pectoral major, patellar tendon ruptures
  • > 4 weeks and patient is unattached to a surgeon, send referral to Calgary Zone FAST Team.
  • Note: If the patient is already under the care of an Orthopedic surgeon for this injury, please contact them
  • Suspected Rotator Cuff Tear or Proximal Biceps Tendon Rupture, refer to CLINICAL PATHWAY: SHOULDER ASSESSMENT
  • Suspected Achilles Tendon Rupture, place patient in plantar flexion (plantar splints) and non-weight-bearing as soon as injury is suspected.
+-
Suspected tendon rupture
For anything > 4 weeks:
  • X-ray of affected body part or joint.
 
N/A
SUSPECTED TENDON RUPTURE (> 4 WEEKS)
Includes: Distal biceps tendon, triceps tendon,
quadriceps tendon, achilles tendon, proximal
hamstring, pectoral major, patellar tendon ruptures
  • > 4 weeks and patient is unattached to a surgeon, send referral  to Zone FAST Team.
  • Note: If the patient is already under the care of an Orthopedic surgeon for this injury, please contact them.
  • Suspected Rotator Cuff Tear or Proximal Biceps Tendon Rupture, refer to
    CLINICAL PATHWAY: SHOULDER ASSESSMENT.
  • Suspected Achilles Tendon Rupture, place patient in plantar flexion (plantar
    splints) and non-weight-bearing as soon as injury is suspected.
+-
Swelling of ankle and/or foot
  • Bilateral, weightbearing views foot and ankle.
  • Weight bearing Foot - Routine: AP Axial and Lateral.
  • Weight bearing Ankle - Routine: AP, AP Oblique 15°-20° medial rotation, lateral.
  • If the patient has diabetes, please include HbA1c.
 
< 3 months of referral
SWELLING - FOOT & ANKLE
  • Send referral to Calgary Zone FAST Team
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
+-
Symptomatic following hip arthroplasty
Routine x-rays: weight bearing AP pelvis centred at pubis, AP Hip of proximal half of affected femur, Lateral view (Lauenstein) of proximal half of affected femur.
 
< 6 months of referral
SYMPTOMATIC HIP ARTHROPLASTY
  • Send referral to Calgary Zone FAST Team 
  • Choosing Wisely recommends not ordering a hip MRI when x-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment.
+-
Synovial disorder of hip joint
Routine x-rays: Weight bearing AP pelvis, AP Hip, Lateral view (Lauenstein).
 
< 6 months of referral
SYNOVIAL DISORDER - HIP
Includes: Pigmented villonodular synovitis (PVNS), osteochondromatosis
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not required. Further tests will be obtained by the specialist if necessary
  • For a patient with normal x-rays and hip pain - MRI is not required.
+-
Tendon pathology of hand and/or wrist
  • If suspecting tear or instability of tendon: Ultrasound.
  • Please specify how many cortisone injections the patient has tried.
 
< 12 months of referral
TENDON PATHOLOGIES – HAND & WRIST
Includes: Instability, tendonitis, tear, DeQuervain’s Tenosynovitis
  • Send referral to Calgary Zone FAST Team.
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.
+-
Trigger finger
Prior to referral, please consider up to 3 cortisone injections approximately 3 months apart, with a lifetime maximum of 3 injections.
 
N/A
  • Include within the referral letter:
    • If the patient has previous intermittent locking/triggering and is unable to extend the finger at all even with passive extension.
    • Please comment on how many cortisone injections the patient has tried.
  • For a digit that cannot be manually unlocked it is a priority referral.
Diagnostic ultrasound is not necessary
 
N/A
TRIGGER FINGER
Intermittent triggering/locking/clicking with digital flexion/extension
  • Refer to Clinical Pathway: Trigger Finger 
  • Send referral to Zone FAST Team.
  • Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.
***For a digit that cannot be manually unlocked send through FAST and it will be prioritized.
+-
Ulcer of foot
  • Bilateral, weightbearing views foot and ankle.
  • Weight bearing Foot - Routine: AP Axial and Lateral.
  • Weight bearing Ankle - Routine: AP, AP Oblique 15°-20° medial rotation, lateral.
  • If the patient has diabetes, please include HbA1c.
 
< 3 months of referral
ULCER - FOOT
  • Send referral to Calgary Zone FAST Team.
  • Additional imaging not recommended. Further tests will be obtained by the specialist if necessary.
+-
Ulnar nerve entrapment
  • Electrodiagnostic study results required as results impact triage decisions.
  • Please specify if wasting and weakness are present.
  • If loss of motion at the elbow, please provide x-ray of the affected elbow completed within 12 months.
 
< 12 months of referral
ULNAR NERVE ENTRAPMENT
Includes: Cubital Tunnel, Guyon’s Syndrome
  • Send referral to Zone FAST Team.
**Please note a collaborative program exists between Orthopedic and
Plastic Surgery in the Calgary Zone.
  • For traumatic nerve injuries, refer to Plastic Surgery, SHC Hand Program or
    Peripheral Nerve Injury Clinic.
+-
Wrist pain
  • X-ray of the affected area.
  • Specify location of pain (radial, central or ulnar, dorsal, volar) and chronicity of pain.
 
< 12 months of referral
WRIST PAIN
Send referral to Calgary Zone FAST Team 
**Please note a collaborative program exists between Orthopedic and Plastic Surgery in the Calgary Zone.

If pain is related to another reason for referral, please order the appropriate investigations.

+-
Urgent Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Dislocation of joint
If available: x-ray of affected body part or joint.
 
N/A
DISLOCATION
Includes: Hip, tibio-femoral, elbow (including locked
dislocation), wrist, ankle, subtalar

URGENT REFERRAL: Call Surgeon on Call through RAAPID.
+-
Fracture
N/A
 
N/A
FRACTURE ( < 4 weeks)
Includes: Non-union, fractures treated (surgically or nonsurgically) outside of patient’s Zone but requiring treatment
or follow up.
  • < 4 weeks – URGENT REFERRAL:Call Surgeon on Call through RAAPID.
Note: If the patient is already under the care of an Orthopedic surgeon for this
injury, please contact them.
+-
Impending pathologic fracture
If available:
  • x-ray of affected body part or joint.
 
N/A
IMPENDING PATHOLOGIC FRACTURE

URGENT REFERRAL: Call Surgeon on Call through RAAPID.
+-
Ligament pathology of hand and/or wrist
If available:
  • x-ray of affected body part or joint.
 
N/A
ACUTE LIGAMENT PATHOLOGIES - HAND and WRIST
Includes: Ligament rupture or injury
  • < 4 weeks – URGENT REFERRAL: Call Surgeon on Call through RAAPID.

+-
Suspected tendon rupture
N/A
 
N/A
SUSPECTED TENDON RUPTURE (<4weeks)
Includes: Distal biceps tendon, triceps tendon, quadriceps
tendon, achilles tendon, proximal hamstring, pectoralis
major, patellar tendon ruptures
  • < 4 weeks – URGENT REFERRAL: Call Surgeon on Call through RAAPID.
  • Note: If the patient is already under the care of an Orthopedic surgeon for this injury, contact them.
  • Suspected Rotator Cuff Tear or Proximal Biceps Tendon Rupture, refer to CLINICAL PATHWAY: SHOULDER ASSESSMENT. 
  • Suspected Achilles Tendon Rupture, place patient in plantar flexion (plantar
    splints) and non-weight-bearing as soon as injury is suspected. 
Additional imaging not required.
Further tests will be obtained by the specialist if necessary.


The primary purpose of the All Locations list is to let the user easily access any location of a healthcare service without going back to the main search screen.

The locations listed have 3 background colors:
  • Green means the healthcare service@location has referral information attached to it.
  • Brown means the healthcare service@location never had referral information attached to it, or it has unpublished referral information.
  • Red means
    • IA changed the healthcare service@location's status to something other than Current
    • It was deleted if it is an ARD healthcare service@location.
Green  and Brown are always at the top of the list. These are the Healthcare Service@Locations with the status of Current.
The Red list at the bottom consists of non-current Healthcare Service@locations that once had Published referral information in the ARD.
If the referral information was never published in ARD the Healthcare Service@location will not show in the Red list.

The secondary purpose of the All Locations list is to allow ARD Administrators to recover (copy) referral information from the non-current Healthcare Service@Locations to ones that are current.

Common Scenario:
A Healthcare Service moves from one location to another. In this case the IA Healthcare Service@Location record will be made defunct (non-current) and a new Healthcare Service@Location record will be created with a current status. In this scenario the captured referral guidelines in ARD can become "orphaned" as they are not attached to any current IA healthcare service.

Categories of non-current or orphaned referral guidelines: INDIVIDUAL and COMMON.
The REFERRAL GUIDELINES section of the profile has the prefix INDIVIDUAL or COMMON to help you choose the method below when transferring referral guidelines from a non-current Healthcare Service@Location to a current healthcare service@location.

Individual referral process
  1. Click on a non-current (Red) Healthcare Service@Location at the bottom of the All Locations list.
  2. The non-current referral info is displayed with the link Copy this Referral Process to another Healthcare Service@Location link on the upper right hand corner. Click on the copy link.
  3. Choose a current location (Green or Brown) from the All Locations list. This will be the Healthcare Service@Location you are pasting the referral info into.
  4. The system will display the Edit Referral Info screen populated with the referral info from the non-current Healthcare Service@Location you viewed in the first step.
  5. Click Save and the referral info is transferred from the non-current Healthcare Service@Location to the current one.
  6. Repeat these steps for each Healthcare Service@Location that needs attention.

Common referral process - 2 sub cases.
Case 1: At least 1 current Healthcare Service@Location with common referral info is with current status for this healthcare service; One or more Healthcare Healthcare Service@Locations where replaced by new one.
  1. Click on any current Healthcare Service@Location whether it has referral info (Green) or not (Brown).
  2. The healthcare service location opens in the Edit Referral Info screen populated with the current common referral info.
  3. Save it. 
  4. All locations will be updated with the common referral information, including all the locations that don't have referral info yet (Brown). The non-current referrals (Red) will also be updated.
Case 2:  All Healthcare Healthcare Service@Locations for a healthcare service are set to a non-current status and replaced by new ones. In this case there is no current additional referral info to copy from, so the only alternative is to pick up the non-current common referral process (Red). Follow the steps described in the section Individual Referral Process above to copy/paste the non-current common referral info to the current healthcare service locations.
Generally we want to replicate current common referral info to new or replaced healthcare service locations. We only resort to copying non-current common referral info if there is no other option.

Remember: Some fields can be location specific with the common referral process:
Parking Instructions, Directions, Parking Map, Wait Time, Referral Phone or Referral Fax.
To update these items you have to edit each Healthcare Service@Location separately.

ADDITONAL NOTES:
  • The info icon after the All Locations drop down will be visible to ARD Administrators.
  • The system doesn't allow you to copy referral information from one non-current Healthcare Service@Location to another.

 

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