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.

  • nil

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

Exclusions

  • unconfirmed lymphoedema, refer to lymphoedema physiotherapy
  • chronic lymphoedema patients who have not trialled compression garments

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • prophylactic lymphoedema surgery

Category 2 — appointment clinically indicated within 90 days

  • acute lymphoedema – less than 6 months onset (optimised comorbidities and medical management)

Category 3 — appointment clinically indicated within 365 days

  • chronic lymphoedema – greater than 6 months onset (optimised comorbidities and medical management)

For more on outpatient referrals, see the general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical history
  • current medication list
  • allergies and sensitivities – including topical application/dressings
  • body mass index (BMI) trends
  • clinical assessment of symptoms:
    • symptoms experienced
    • presence of wounds
    • onset, duration, and frequency
    • attempts to optimise associated conditions e.g. renal dialysis, cardiac failure, cancer patient- surgical interventions/radiation therapy/lymph node excision
  • community services in place e.g. community nursing for hygiene/dressing/wound management
  • current compression grade trialled/tolerance to compression therapy

Clinical management advice

This CPC has been developed for consideration of surgical management for lymphoedema. Risk reduction of lymphoedema focuses on surgical or radiotherapy techniques to reduce the impact on the lymphatic system.

Most people experiencing lymphoedema do not require referral to a tertiary institution. Accessing community resources (refer to Clinical management advice and resources) can assist in hospital avoidance with similar outcomes and reduced wait times for consultation.

Each Local Health Network provides lymphoedema therapy services including assessment for diagnosis, management including compression garments

A trial of non-surgical management with an accredited lymphedema therapist must occur prior to referral to the plastics lymphoedema service.

The lymphoedema surgery service is based at the Royal Adelaide Hospital. All conservative lymphoedema management options must be ongoing as surgery does not replace the need for ongoing compression therapy.

It is strongly recommended that people who smoke or vape stop 3 months prior to consultation. Smoking/vaping is associated with delayed healing. Please refer to useful resources section for further information.

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