Referral to emergency

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

  • if the following symptoms/signs occurs immediately (within the observation time after vaccination):
    • loss of consciousness which does not resolve in the supine position, indicating likely vasovagal syncope
    • generalised rash (urticaria/angioedema/flushing) with cardiovascular and/or respiratory and/or gastrointestinal symptoms/signs - suspect and treat for anaphylaxis prior to referral
    • any other severe symptoms or signs such as sudden onset respiratory (e.g. wheeze/stridor), cardiovascular (hypotension) or neurological (tonic/clonic movement) signs

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

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


Inclusions

  • serious adverse event following immunisation (AEFI) – see ‘after vaccination’ section of The Australian Immunisation Handbook for examples
  • patients with a medical at risk (MAR) condition who are considered as medically unstable
  • patients with a medical condition that may be associated with an increased risk of a reaction after vaccination or require complex immunisation schedules
  • patients who are unimmunised or under-immunised because of significant vaccine concerns that have not been addressed by community immunisation and/or health providers
  • families with specific issues regarding COVID-19 vaccines.
  • families seeking exemption to No Jab No Play legislation (the SIS cannot provide an exemption but can perform a review which can be provided to SA Health - all applications for an exemption to No Jab No Play must be submitted to SA Health)
  • families seeking a secretary’s exemption to No Jab No Pay legislation
  • if vaccine required urgently, please call service directly, see ‘contacts for clinical advice’

Exclusions

  • patients with egg allergy who require the measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) vaccines - these vaccines do not contain egg
  • patients with egg allergy who require the seasonal influenza vaccine - this vaccine can be given in the community in these egg allergic children
  • patients with food allergy and eczema - these children can be safely vaccinated in the community.
  • children requiring sedation for immunisation due to neurodevelopmental concerns or needle phobia
  • children requiring catch up immunisations – these can be referred to the Women’s and Children’s Hospital Immunisation Clinic
  • children requiring Bacille Calmette-Guerin (BCG) vaccines – please refer to the Royal Adelaide Hospital Chest Clinic

Triage categories

All patients requiring review in this clinic will be appointed within a timeframe that where possible ensures that they receive their scheduled vaccines on time.

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.

  • previous vaccines and adverse events
  • background medical/social issues
  • vaccines associated with event
  • time interval between vaccine and onset of symptoms
  • treatment required
  • resolution of symptoms

Additional information to assist triage categorisation

  • a comprehensive referral letter should be sent documenting which vaccines and/or medication administered as well as a detailed description of symptoms and signs including time to onset (post-vaccination) and progression

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.