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 and/or infected eczema with concern for sepsis
  • severe faltering growth

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

  • severe early onset eczema with associated severe infections and/or immune dysregulation with concern for inborn error of immunity, refer urgently via on-call service
  • uncomplicated and mild-moderate atopic eczema
  • screening for food allergies in the context of eczema
  • eczema without history of allergies to food, refer to Eczema CPC - Dermatology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • severe uncontrolled eczema despite adequate topical therapies in child less than 12 months of age associated with
    • a pattern of consistent eczema exacerbations following consumption of specific food/s
    • faltering growth or risk of nutritional compromise
    • diarrhea and/or severe recurrent infections

Category 2 (appointment clinically indicated within 90 days)

  • eczema with optimal skin management, see clinical management advice
  • uncontrolled eczema with strong indication of food allergy related exacerbation (based on reaction or immunoglobulin E (IgE)) in child greater than 12 months of age
  • severe eczema in a child less than 5 years of age where optimal skin management has been implemented and failed
  • eczema of any severity if referred by dermatologist

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.

  • duration and severity of symptoms
  • treatments trialed, compliance and responses
  • effects on day-to-day living, including any faltering growth, sleep disturbance, itch etc.
  • possible triggers - clearly indicate if food allergy is suspected cause
  • current diet, any previous food eliminations and effect of these
  • growth parameters/centiles, both height/weight
  • medical history including any other allergies, family history of atop

Additional information to assist triage categorisation

  • disease activity score e.g. Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI)
  • bacterial or viral skin swab if infection is present

Allergy & Anaphylaxis Australia have trained health professionals (doctors, registered nurses and dietitians) responding to clinician and consumer enquiries through the national allergy support phone line and website.

Clinical management advice

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.