Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • nil

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Exclusions

  • controlled or mild rhinoconjunctivitis
  • allergic rhinitis/rhinoconjunctivitis (hay fever) without trial of treatment (intranasal corticosteroid nasal spray (ICNS) and antihistamine) for at least six weeks
  • isolated high total immunoglobulin E (IgE) and/or specific IgE or mild-moderate eosinophilia without relevant clinical symptoms

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • vernal keratoconjunctivitis (VKC) associated with acute allergic conjunctivitis – must also be referred to ophthalmology for urgent assessment

Category 2 (appointment clinically indicated within 90 days)

  • persistent and uncontrolled seasonal rhinitis that has not responded to standard treatment implementation and is impacting quality of life
  • allergic rhinitis/rhinoconjunctivitis (hay fever) of any severity if referred by ear, nose and throat (ENT) specialist 

Category 3 (appointment clinically indicated within 365 days)

  • allergic rhinitis/rhinoconjunctivitis (hay fever) of any severity if referred by paediatrician

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Additional information to assist triage categorisation

  • symptoms including:
    • nasal obstruction/discharge, disturbance of smell or taste
    • facial pain, frontal headaches
    • impacts on quality of life, including school performance/work productivity
  • examination findings: swollen mucosa, secretions, ensure symptoms are not due to nasal foreign body, look for nasal polyps (presents with congestion and loss of sense of smell)
  • total immunoglobulin E (IgE) and specific IgE for suspected aeroallergen triggers – this may inform interim management strategies (see ASCIA — Allergen Minimisation and SA Pathology Allergy Testing Guidelines)
  • state if the patient is under the care of an Ear, Nose & Throat (ENT) specialist, and management trialled under this care

Clinical management advice

Consider other differential diagnoses in children less than three years old

  • rule out   
    • non-allergic causes of rhinitis e.g. vasomotor rhinitis, bacterial and viral infections, sinusitis
    • overuse of decongestant sprays (less common)
    • tumours or vocal chord dysfunction (rare)
    • nasal foreign body
  • consider asthma – allergic rhinitis and asthma frequently co-exist and effective treatment of rhinitis can improve asthma symptoms.

Management advice

  • commence intranasal corticosteroid nasal spray (ICNS) as first line treatment for perennial and seasonal allergic rhinitis (see Clinical Resources for more information)
  • trial antihistamine - less sedating oral antihistamines can be used to manage itching and sneezing or associated eye symptoms. There is NO role of SEDATING antihistamines in the management of rhinitis
  • nasal irrigation with saline spray can be effective in children with allergic rhinitis, possibly due to enhanced cillary function or removal of inflammatory cytokines via mucus clearance
  • ensure allergen minimisation, see Australasian Society of Clinical Immunology and Allergy (ASCIA) — Allergen Minimisation
    • where history and blood immunoglobulin E (IgE) test positive for pet or dust mite, consider allergen avoidance
    • reassure patients that food allergies do not cause allergic rhinitis rhinitis in response to fumes (e.g. fragrances and paints) is not an allergic reaction
  • intranasal and oral decongestants are not recommended and can only be used for short courses

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.