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 uncontrolled asthma
  • acute exacerbation of asthma not responding to therapy
  • asthma with any of the following concerning features
    • coexistent pneumothorax
    • pneumonia
    • signs of respiratory distress
    • if the patient has a silent chest, cardiovascular compromise, relative bradycardia or decreasing rate and depth of breathing, these are all signs of an impending respiratory arrest and require urgent medical attention
  • respiratory distress leading to
    • cyanosis
    • dyspnoea
    • tachypnoea 
    • intercostal/subcostal retractions
    • tracheal tug
  • haemodynamic instability

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

For clinical advice, please telephone the relevant specialty service.

Asthma Australia

  • 1800 ASTHMA (1800 278 462) 8:30 am to 4:30 pm, Monday to Friday

Southern Adelaide Local Health Network

Women's and Children's Health Network

Inclusions

  • complex asthma presentations

Exclusions

  • asthma without first line management in line with the Australian Asthma Handbook
  • bronchiolitis — refer to emergency department if concerns of respiratory distress

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recent history of severe or life-threatening respiratory illness history in the past 12 months requiring ventilation or intensive care admission
  • asthma with unexplained clinical findings e.g. focal signs, abnormal voice or cry, dysphagia, inspiratory stridor

Category 2 (appointment clinically indicated within 90 days)

  • recurrent asthma attacks (≥ 3 per year) requiring hospitalisation or steroids in the last 12 months
  • asthma with inadequate control despite conventional treatment, particularly inhaled corticosteroids above 250 micrograms per day of fluticasone propionateequivalent
  • uncertainty about diagnosis of asthma

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.

  • number and nature of asthma exacerbations, including any severe asthma attacks requiring hospital or intensive care admissions
  • severity and frequency of symptoms including any sleep, feeding or exercise related symptoms.  In Indigenous populations, clinicians should consider documenting the language used by child/family to describe asthma, for example ‘short wind’
  • severity and frequency of interval symptoms. In Indigenous populations, clinicians should consider documenting the language used by child/family to describe asthma, for example ‘short wind’
  • symptom triggers e.g. cold air, exercise, pollens, viral infections
  • current and previous growth parameters including weight, length/height and head circumference
  • current and previous medications
  • extent of school absenteeism or limitation in daily function
  • copy of asthma action plan

Additional information to assist triage categorisation

  • consider spirometry if patient is > 6 years old
  • assessment of adherence to medication
  • immunisation, developmental and medical history
  • history of atopy/allergic disease and family history of same. Atopic dermatitis is a significant issue for Aboriginal children, but may be undiagnosed - consider assessment for previously undiagnosed atopy, particularly in individuals with darker skin. See Clinical Resources for further information

Clinical management advice

  • optimise asthma therapy in line with the Australian Asthma Handbook, including assessment of device technique and adherence to treatment
  • develop an asthma action plan
  • treat allergic rhinitis if present, as this can exacerbate asthma symptoms
  • avoid certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs, beta-blockers and ‘natural remedies’ such as echinacea or royal jelly that may cause allergic reaction
  • if patient does not meet inclusion criteria for referral to Paediatric Respiratory & Sleep Medicine, consider referral to Paediatric General Medicine
  • Paediatric Allergy & Immunology accept referrals from respiratory physicians for consideration of allergen immunotherapy

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.