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.

  • acute exacerbation of asthma not responding to therapy
  • life threatening or persistent severe asthma
  • asthma with any of the following concerning features:
    • coexistent pneumothorax
    • pneumonia
    • silent chest
    • cardiovascular compromise
    • altered consciousness
    • relative bradycardia
    • decreasing rate and depth of breathing
  • acute respiratory distress/acute respiratory failure
    • suspected or known respiratory disease presenting with:
      • imminent cardiorespiratory arrest
      • anaphylaxis or angiooedema
      • acute onset or worsening of breathlessness.
      • confusion, drowsiness, very fast or very slow breathing, not able speak in full sentences at rest due to breathing difficulty, significant increase in the use of accessory muscles of respiration (e.g. neck muscles), cyanosis
      • finger pulse oximetry (SpO2) < 90% if this is not normal for the patient or significant worsening of the patient’s baseline SpO2.
      • new onset low blood oxygen or high blood carbon dioxide level, or significant worsening of blood oxygen or carbon dioxide level from the patient’s baseline, if arterial blood gas results are available.
    • these signs/symptoms/parameters may be accompanied by a high heart rate or blood pressure changes, significantly higher or lower than the patient’s baseline

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

  • Flinders Medical Centre, request Respiratory Consults Registrar (08) 8204 5511

Inclusions

  • diagnosed asthma (airflow obstruction with acute bronchodilator response; forced expiratory volume (FEV1) variability over time) with ongoing poor asthma control – persistent symptoms; frequent and/or life-threatening exacerbations or hospitalisations; persistent airflow obstruction or poor response to optimized asthma treatment
  • diagnosis unclear
    • e.g. there are unexpected clinical findings e.g. crackles, clubbing, cyanosis, systemic features e.g. weight loss, myalgia, fever
    • unexplained restrictive spirometry
  • suspected occupational asthma
  • marked peripheral eosinophilia

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • history of life-threatening asthma in the past 12 months requiring ventilation or ICU admission
  • unstable asthma e.g., severe or persistent symptoms, or with FEV1 < 60% predicted.
  • asthma caused or exacerbated by workplace exposure where patient is unable to work as a result.

Category 2 (appointment clinically indicated within 90 days)

  • inadequate asthma control despite optimal treatment, see ‘Clinical Management Advice and Resources’
  • concern regarding alternative diagnosis
  • asthma related hospital admission/s in the last three months
  • need for oral corticosteroids on more than one occasion in the last year
  • asthma with frequent after-hours attendance despite optimal treatment. After hours attendance includes emergency department or after-hours general practitioner
  • asthma caused or exacerbated by workplace exposure where patient is still able to work as a result

Category 3 (appointment clinically indicated within 365 days)

  • uncertainty about diagnosis without any other red flag symptoms
  • asthma education where this cannot be provided in the community

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.

  • age at diagnosis
  • duration and severity of symptoms
  • current and past treatment/s including inhaled steroids, inhaled bronchodilators and systemic treatments
  • assessment of adherence to treatment/s
  • other co-morbidities including history of allergies, e.g. allergic rhinitis, atopic dermatitis
  • recent hospitalisations including emergency department presentations and intensive care unit or high dependency unit admissions
  • smoking history
  • usual and current Peak Expiratory Flow Rate (PEFR)
  • exam
    • respiratory distress, oxygen saturation (SaO2) if available
    • auscultatory findings (wheeze/crackles)
  • spirometry if available
  • chest x-ray (CXR)
  • full blood count (FBC)

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number
  • other tests confirming diagnosis of asthma, if available
  • allergy testing results

The aim of asthma management is to control the disease. Complete control is defined as:

  • no day or night symptoms
  • minimal (less than two times per week) or no need for beta agonist treatment
  • no exacerbations
  • no limitations on physical activity
  • minimal side effects of treatment

Clinical management advice

  • optimise usual asthma therapy, including assessment of device technique and adherence to treatment, see ‘Clinical Resources’ for clinical guidelines
  • develop written asthma action plan, see ‘Clinical Resources’ for templates
  • consider and ensure appropriate management of other triggers e.g.:
    • smoking
    • medications such as non-steroidal anti-inflammatory drugs (NSAIDs), beta blockers
    • diet
    • conditions such as sleep apnoea, gastro-oesophageal reflux disease (GORD), allergic rhinitis
    • environmental allergens

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.