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.

  • complications of disease or therapy requiring emergent review – systemically unwell
  • evidence of systemic or major organ involvement, for example, acute new onset breathlessness
  • new or severe hypertension in someone with systemic sclerosis (scleroderma) which may indicate renal crisis
  • suspected sepsis
  • unexplained illness or fever in a patient being treated with biologic or immunosuppressant medications

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • people who are antinuclear antibody (ANA) positive with no symptoms or signs of autoimmune connective tissue disease

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • any new onset connective tissue disease with active organ involvement, for example:
    • systemic lupus erythematosus with organ involvement
    • systemic sclerosis (scleroderma) with diffuse skin and/or organ involvement
    • inflammatory muscle disease with weakness

Category 2 (appointment clinically indicated within 90 days)

  • any connective tissue disease without active organ involvement, for example:
    • systemic lupus erythematosus with only musculocutaneous involvement
    • systemic sclerosis (scleroderma) without diffuse skin and/or organ involvement
    • inflammatory muscle disease without weakness
    • undifferentiated and overlap connective tissue disease, mixed connective tissue disease, Sjogren’s disease

Category 3 (appointment clinically indicated within 365 days)

  • autoimmune connective tissue disease for exclusion with minimal symptoms

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.

  • if the patient is pregnant or planning a pregnancy
  • complete medical history
  • previous assessments or opinions from a rheumatologist or other relevant specialist or allied health clinician

History of presenting condition

  • duration of symptoms
  • specific clinical features under suspicion
    • rash, mouth ulcers, joint pain, pleurisy, anaemia, leukopenia, thrombocytopenia, active urine sediment or proteinuria if lupus suspected
    • Raynaud’s phenomenon or skin thickening if scleroderma suspected

Clinical examination

  • rashes
  • blood pressure
  • joint swelling
  • muscle power
  • breath sounds/ chest examination

Blood results, including location of company and accession number if available

  • full blood count (FBC)
  • electrolytes, urea, creatinine (EUC)
  • estimated glomerular filtration rate (eGFR)
  • liver function tests (LFTs)
  • C- reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • complement levels (C3, C4)
  • rheumatoid factor (RF)
  • anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • antinuclear antibody (ANA) titre and pattern must be included, if ANA is positive, extractable nuclear antigen (ENA) and dsDNA
  • urinalysis
  • creatinine kinase (CK)

Additional information to assist triage categorisation

  • ethnicity/geographic origin
  • family history of autoimmune disease
  • relevant allied health/diagnostic/imaging reports including location of company and accession number
  • interference with activities of daily living and working ability — for example, has the patient had to stop or change work practices, are they requiring assistance with self-care

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.