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.

  • angioedema affecting oropharyngeal or laryngeal area with potential airway compromise

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

Southern Adelaide Local Health Network

Exclusions

  • patients under 17 years old
  • patients being treated for same condition at other hospital.
  • acute or chronic urticaria which has remitted, if urticaria remits while patient is on the waiting list, the appointment can be cancelled

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • angioedema with complement level (C4) or family history of hereditary angioedema
  • urticarial vasculitis or urticaria associated with systemic inflammatory disease
  • severe chronic urticaria with or without angioedema, not responding to antihistamine, requiring oral corticosteroid for relief

Category 2 (appointment clinically indicated within 90 days)

  • recurrent angioedema
  • urticaria > 6 weeks duration not responding to antihistamine

Category 3 (appointment clinically indicated within 365 days)

  • chronic urticaria responding to antihistamines

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.

Angioedema

  • frequency, severity and site of swelling, airway involvement
  • family history of angioedema
  • angiotensin-converting enzyme (ACE) inhibitor usage
  • history of lymphoproliferative disorder
  • possible allergic precipitants, for instance drug/food/venoms
  • complement level (C4) level

Urticaria

  • duration
  • response to antihistamines, any other treatments
  • coexistence of angioedema

Clinical management advice

Angioedema

  • cease ACE-inhibitors
  • for recurrent angioedema, consider commencing regular prophylactic non-sedating antihistamine

Urticaria

  • trial the following for two weeks
    • non-sedating antihistamines, can use up to 4x standard dose
    • add H2 antihistamines, nizatidine or famotidine
    • montelukast
    • prednisolone use should be restricted to very severe exacerbation and limited to 3 to 7 days
  • urgency category is dependent on response to treatment measures recommended above
  • urticaria may remit, and in this case, referral/appointment can be cancelled

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.