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 or persistent epistaxis

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • epistaxis with suspicion of a tumour on imaging, specify on referral

Category 2 — appointment clinically indicated within 90 days

  • unilateral epistaxis in adolescent male aged 16 to 18 suspicion of juvenile nasopharyngeal angiofibroma (JNA)

Category 3 — appointment clinically indicated within 365 days

  • epistaxis not responding to maximal medical management for > 6 to 8 weeks e.g. topical creams, no nose picking, manage allergic rhinitis
  • epistaxis - please describe frequency and duration
  • minor recurrent epistaxis

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.

  • presenting complaint history and symptoms including:
    • vision disturbance
    • dental malignancy
    • cerebrospinal fluid (CSF) leak
  • details of previous medical management including:
    • systemic and topical medications prescribed
    • duration and outcome of the treatment
  • current medication list including any:
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
    • aspirin or warfarin and
    • anti-hypertensives
  • complete blood exam (CBE)
  • coagulation profile
  • relevant reports and results

Additional information to assist triage categorisation

High resolution computerised tomography (CT) if concerns of juvenile nasopharyngeal angiofibroma (JNA), including company and accession number.

Clinical management advice

Medical management (refer to The Royal Australian College of General Practitioners (RACGP) Epistaxis Guidelines) and consider investigation for:

  • clotting disorders
  • hypertension/management of hypertension

Clinical 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.