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.

  • fever
  • weight loss
  • very high inflammatory markers (CRP > 50mg/L) with evidence of major organ involvement e.g. acute renal injury
  • cerebrovascular compromise

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Inclusions

  • recurrent episodic fever, rash, arthritis, abdominal pain, constitutional symptoms in absence of infective/lymphoproliferative cause
  • family member with a confirmed autoinflammatory condition
  • unexplained fever and inflammation in an older person (VEXAS syndrome)
  • familial cold autoinflammatory syndrome (FCAS)/cryopyrin associated periodic syndrome (CAPS)

Exclusions

  • patients under 17 years old

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recurrent or persistent unexplained fever and inflammation in an older person (VEXAS)
  • known familial cold autoinflammatory syndrome (FCAS)/cryopyrin associated periodic syndrome (CAPS)
  • recurrent episodic fever, rash, arthritis, abdominal pain, constitutional symptoms in absence of infective/lymphoproliferative cause
  • family member with a confirmed autoinflammatory condition where the patient is symptomatic and treatment-naïve

Category 2 (appointment clinically indicated within 90 days)

  • patient with family member with confirmed autoinflammatory disease and patient is asymptomatic

Category 3 (appointment clinically indicated within 365 days)

  • nil

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.

  • symptom profile and duration, including:
    • fever or weight loss
    • rash – nature and pattern
    • triggers e.g. cold exposure
    • any major organ systems involved
  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • complement levels 3 and 4
  • full blood count (FBC)
  • antinuclear antibody (ANA), rheumatoid factor (RF)
  • immunoglobulins (Ig): IgG, IgA, IgM, IgG4
  • angiotensin-converting enzyme (ACE) level

Additional information to assist triage categorisation

  • treatment or specialist review to date
  • urinalysis, spun sediment for red cell casts

Clinical management advice

  • symptomatic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) or systemic corticosteroids
  • if suspected autoinflammatory disease refer to immunology, if systemic autoimmune disease refer to autoimmune disease CPC

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.