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.

  • suspicion of acute rheumatic fever (ARF)

For clinical advice, please telephone the relevant specialty service.

Suspected acute rheumatic fever (ARF)

For clinical advice regarding diagnosis and management of suspected acute rheumatic fever (ARF), contact Paediatric Medicine team.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women’s and Children’s Hospital Network

Regional health networks

Suspected cardiac complications

For clinical advice regarding suspected cardiac complications, contact the following and request to speak with the on-call Cardiology registrar or Cardiologist.

Women’s and Children’s Hospital Network

Inclusions

  • confirmed or suspected rheumatic fever (RF) or rheumatic heart disease (RHD)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected acute rheumatic fever (ARF) – requiring cardiology review and echocardiogram (Echo)

Category 2 (appointment clinically indicated within 90 days)

  • follow-up of diagnosed ARF/rheumatic heart disease (RHD) – has had Echo

Category 3 (appointment clinically indicated within 365 days)

  • long-term follow-up of ARF/RHD known to cardiology

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.

  • clinical history including:
    • presenting symptoms – sore throat, joint pain, rash, non-weight bearing
    • rheumatic fever (RF) diagnosis parameters, e.g. fever, inflammatory markers, joint pain, rash, chorea
    • associated symptoms, e.g. fatigue, exercise intolerance, syncope
    • family history of RF/rheumatic heart disease (RHD)
    • previous sore throat/joint pain/rash – including treatment provided
    • previous episodes/diagnosis of RF, including previous treatment and prophylaxis
  • medical history
  • medications and allergies
  • physical examination findings:
    • blood pressure including trends, postural blood pressure
    • heart rate (HR)
    • cardiac exam findings
  • investigations:
    • current bloods e.g. inflammatory markers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)
    • antistreptolysin O titres (ASOT)/anti DNaseB
    • electrocardiogram (ECG)/chest x-ray (CXR)
    • throat swab result if available
  • current management provided and timing of last bicillin injection

Clinical management advice

Any patients with suspected or confirmed rheumatic fever (ARF) or rheumatic heart disease (RHD) should be referred to cardiology to assess for rheumatic heart disease.

Rheumatic fever is a notifiable disease and needs to be reported - Notifiable Disease Reporting Form

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 role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) 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 referring clinician once the transfer of care has occurred.