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.

  • suspected deep tissue infection (presence of bullae, necrosis or subcutaneous emphysema)
  • suspected necrotising fasciitis
  • facial or orbital cellulitis
  • rapidly progressing infection
  • rapidly progressing haematoma
  • underlying vascular or tendon injury
  • hand infections - fingertip, flexor tendon infection, abscess
  • deep penetrating tissue injury
  • skin threating injury e.g. haematoma, large skin tear
  • soft tissue loss greater than 5cm2
  • uncontrolled pain after analgesia
  • numbness, weakness, or lack of perfusion distal to injury
  • systemic features including:
    • febrile greater than 38oC
    • haemodynamic instability
    • positive blood cultures
    • rising or unchanging C-reactive protein (CRP) or white cell count (WCC) unresponsive to antibiotics
    • hypotension
    • tachycardia

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • abscess of the torso or lower limbs
  • dental origin abscess

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • skin tears
  • soft tissue trauma
  • haematoma
  • abscess of upper limb, face, head, and neck
  • trauma related delayed healing lacerations/wounds

Category 2 — appointment clinically indicated within 90 days

  • earlobe trauma

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.

  • past medical/surgical history
  • current medications and dosages
  • allergies and sensitivities
  • presenting symptoms
  • management history including:
    • onset and duration
    • severity
    • pain
    • associated features
  • delayed wound healing:
    • wound management plan including community management, frequency and dressings applied
    • punch biopsy if wound present equal to or greater than 28 days
    • social situation – does person live independently/supported care/aged care facility
  • concerns of soft tissue infection or abscess:
    • complete blood examination (CBE)
    • urea and electrolytes (EUC)
    • liver function test (LFT)
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • motor/sensory assessment (hand presentation)
  • ultrasound (US) for suspected abscess

Additional information to assist triage categorisation

  • photograph including disposable measurement tool – with patient’s consent, where secure image transfer, identification and storage is possible

Clinical management advice

All soft tissue infection or injuries not requiring emergency department presentation are triaged as a category 1 and require assessment within 7 days – please contact the on-call registrar to ensure any referrals can be actively followed up.

All dental trauma requires referral to oromaxillofacial for management and treatment.

Consider elevation as part of any treatment plan for soft tissue injury/infection.

If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.

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.