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.

  • bleeding vascular lesion that does not coagulate after 15 minutes of firm pressure
  • secondarily infected ulcerated vascular lesion

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

  • vascular malformations
  • vascular lesions for consideration of medical and laser treatments
  • pyogenic granulomas
  • infantile haemangiomas, also known as haemangioma of infancy or strawberry naevus

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • any vascular growth of uncertain diagnosis
  • rapidly changing/growing vascular tumour in areas of functional/cosmetic significance (periocular/perinasal/perioral/beard area/abutting important structures)
  • bleeding/ulcerated vascular lesion without evidence of infection
  • multiple haemangioma of infancy (five or more) in any body location
  • segmental port-wine stain, also known as capillary malformation

Category 2 (appointment clinically indicated within 90 days)

  • rapidly changing/growing vascular tumour on other body parts

Category 3 (appointment clinically indicated within 365 days)

  • port-wine stain for consideration of vascular laser

Clinical management advice

Infantile haemangiomas are the most common soft tissue tumour in children aged less than one year of age and occur in 4 to 10% of infants. They are more common in female and premature infants. Whilst some present as an area of pallor or a pink spot at birth, most arise in the first weeks of life. In the first one to six months of life, haemangiomas grow quickly before entering a stabilisation phase. Subsequently, haemangiomas begin to spontaneously resolve, and regression is complete in 60% of 4 year olds and 76% of 7 year olds. Haemangiomas do not always need to be treated. Urgent referral is indicated for:

  • rapidly proliferating facial haemangiomas, particularly around the eye, nose or lips - these may cause severe anatomic distortion or pose functional risks (e.g. visual obstruction, lazy eye [amblyopia], feeding difficulties)
  • haemangiomas affecting the beard area on the face or neck, these increase the risk of airway obstruction.
  • segmental haemangiomas (large lesions with geographic patterning over an anatomic region—these may be associated with other congenital abnormalities
  • ulcerated or bleeding lesions, most common in the nappy area or on the lip
  • very large haemangiomas, these increase the risk of cardiac failure and hypothyroidism. For these patients, the use of oral beta-blockers is often recommended
  • for smaller haemangioma of infancy, watchful waiting or the use of (off-label) topical timolol 0.5% drops BD can be helpful.

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.