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.

  • acute anaphylaxis:
    • difficult/noisy breathing
    • swelling of tongue
    • swelling/tightness in throat
    • difficulty talking and/or hoarse voice, wheeze, or persistent cough
    • persistent dizziness or collapse
    • persistent abdominal pain and/or vomiting after taking a medication
  • adrenaline has been administered
  • severe rash with blistering or mucosal ulceration, or accompanied by fever or liver or kidney injury

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

Exclusions

  • patients under 17 years old
  • patients being treated for same condition at other hospital
  • non-allergic (not immune mediated) drug reactions
  • drug intolerance or side-effects

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • allergy to urgently required drug with no alternative, for consideration of desensitisation
  • distant or mild penicillin/cephalosporin allergy label but urgent need for antibiotics/frequent antibiotic needs

Category 2 (appointment clinically indicated within 90 days)

  • allergy to multiple different drugs with restricted choices
  • antibiotic allergy where the patient is subject to frequent infections, or with immunodeficiency
  • severe allergic reaction with multiple drug culprits, for determination of likely cause

Category 3 (appointment clinically indicated within 365 days)

  • distant or mild penicillin/cephalosporin allergy label but no urgent need for antibiotics

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.

  • history of drug/s ingested and dose/s, including drug brand name
  • documented symptoms and severity, as well as interval between exposure and reaction
  • medication list at time of event, including over the counter, illicit and homeopathic drugs
  • comorbidities including immunodeficiency
  • any known prior drug allergies
  • reason for prescribed drug use, and likelihood that it or related drugs will be required again.
  • if suspecting anaphylaxis: ideally order Tryptase within three hours of reaction, as well as a follow up tryptase at least 24 hours after the event
  • if suspecting penicillin/cephalosporin allergy: order specific Immunoglobulin E (IgE) to Amoxicilloyl, Penicilloyl V, Penicilloyl G and Cefaclor
  • if isolated angioedema, order complement component 4 (C4) level

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.