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.

  • severe acute infection

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
  • secondary immunodeficiency due to haematological disorder, immunosuppressive medication, refer back to specialist, Immunology may see if referred by specialist
  • immunodeficiency secondary to human immunodeficiency virus (HIV) infection

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected immunodeficiency with frequent severe infections
  • very low immunoglobulin (Ig) levels/hypogammaglobulinemia (IgG < 2g/L)
  • severe atypical or opportunistic infections

Category 2 (appointment clinically indicated within 90 days)

  • suspected immunodeficiency without frequent severe infections
  • low immunoglobulin levels
  • atypical or opportunistic infections
  • secondary immunodeficiency on referral from haematology, oncology or other specialist service

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.

  • history of infections demonstrating one or more of the following:
    • 4 to 6 sinopulmonary infections/year requiring antibiotics
    • sinopulmonary infections with a prolonged duration requiring multiple courses of oral antibiotics or intravenous antibiotics
    • chronic suppurative lung disease/bronchiectasis, unknown cause
    • recurrent meningitis
    • recurrent and severe infections with environmental mycobacteria and usually harmless viral or opportunistic pathogens
    • recurrent internal organ abscesses, e.g. lung, liver
    • persistent extensive oral/oesophageal thrush or cutaneous fungal infection
    • recurrent deep-seated infections including septicaemia in the absence of an alternative cause
  • onset, duration, location, types of infectious organisms
  • severity of infections, treatment trialled and response
  • family history of immunodeficiency and autoimmunity
  • current management
  • full blood count, with differential
  • immunoglobulins (Ig): IgG, IgA, IgM and IgE
  • chest x-ray or computed tomography (CT), if history of recurrent chest infections or bronchiectasis
  • lymphocyte subsets
  • vaccination history

Clinical management advice

  • treat infections in the usual manner
  • isolate the causative organism, if possible – culture, microscopy polymerase chain reaction (PCR) etc.
  • hold live attenuated viral vaccinations, including rotavirus, measles-mumps-rubella (MMR) and varicella, pending specialist assessment

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.