What criteria should I use to decide whether to refer a patient with c

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Criteria for referral of a patient with chronic bursitis to a specialist include:

Refer urgently or seek specialist advice if the patient has septic bursitis that does not respond or inadequately responds to antibiotic treatment, as they may require a change in antibiotic, intravenous antibiotics, or surgical intervention such as incision and drainage ,,.
Refer if aspiration of the bursa is needed but there is no expertise available in primary care ,.
Refer patients with recurrent septic bursitis for consideration of surgical excision of the bursa, but only after infection has cleared ,.
Consider referral if a patient with non-septic bursitis, in whom septic bursitis has been excluded, does not respond to conservative management after 2 months, or sooner if symptoms are severe (e.g., significant discomfort), as corticosteroid injection or surgical management may be beneficial ,,.
Refer patients with systemic signs of infection or inflammation, immunocompromise, severe septic bursitis with necrosis of overlying skin, or severe soft tissue infection for hospital admission and specialist care ,,.
Refer patients with persistent infection despite appropriate antibiotic treatment, infection with difficult-to-treat organisms (e.g., environmental fungi), sepsis, underlying osteomyelitis, abscess, fistula, skin necrosis, foreign body, or chronic/refractory non-septic bursitis for specialist assessment ,,.
Referral should be made sooner than 2 months if there are symptoms suggestive of septic bursitis ,,.

What criteria should I use to decide whether to refer a patient with chronic bursitis to a specialist?