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.

  • drug reaction with eosinophilia and systemic symptoms (fever, abnormal liver function tests)
  • Stevens-Johnson syndrome, severe cutaneous adverse reaction
  • cardiorespiratory compromise
  • anaphylaxis*. Symptoms include:
    • difficult/noisy breathing
    • swelling of tongue
    • swelling/tightness in throat
    • difficulty talking and/or hoarse voice, wheeze, or persistent cough
    • persistent dizziness or collapse
    • pale and floppy in young children
    • persistent abdominal pain, vomiting are signs of severe allergic reaction to drugs/ insects
  • symptoms have required the administration of adrenaline

*Refer to the Australasian Society of Clinical Immunology and Allergy (ASCIA) Guidelines – Acute Management of Anaphylaxis for the definition of and recommended treatment for anaphylaxis.

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

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Exclusions

  • non-allergic (not immune mediated) drug reactions
  • adverse reactions to drugs in keeping with known adverse reactions to the drug

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • complex drug allergy – multiple drugs, co-morbidity, no alternates available, drug required for treatment (e.g. Cystic Fibrosis), challenge testing is required to identify a safe drug for use
  • anaphylaxis to a medication

Category 2 (appointment clinically indicated within 90 days)

  • patients who have had delayed rash (after 48 hours) following Penicillin and who are able to tolerate other antibiotics

Category 3 (appointment clinically indicated within 365 days)

  • simple drug allergy – single drug, no co-morbidity, alternates available

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

  • type of medication/s including formulation and brand name
  • onset, time course and details of symptoms in relation to medication
  • any underlying medical condition at the time that could explain the symptoms
  • all medications being taken at time of event, including over the counter, illicit and homeopathic drugs
  • reason for prescribed drug use, and likelihood that it or related drugs will be required again.
  • any medications trialled subsequently to treat initial condition. If antibiotic allergy list all antibiotics prescribed since.
  • past medical history including asthma, and known prior drug allergies

Additional information to assist triage categorisation

  • advise patients to bring any photos of reaction to appointment

Clinical management advice

  • cease suspected drug
  • use alternative drug if available
  • inform patients of potential cross-reactivity including over the counter medications e.g. non-steroidal anti-inflammatory drug (NSAID) reactions
  • consider medical identification jewellery
  • update relevant medical records
  • please note patients with drug allergies, including anaphylaxis, do not require an adrenaline injector
  • where there is a pressing clinical need, temporary desensitization may be considered, and should be discussed directly with the on-call Immunologist

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.