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.
- 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
- Lyell McEwin Hospital
(08) 8182 9000
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
- Women’s and Children’s Hospital (08) 8161 7000
Exclusions
- local reactions to insect stings/bites without any systemic features
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- anaphylaxis to insect venom – in insect allergy, anaphylaxis may include abdominal pain, vomiting. Note anaphylaxis may resolve without the use of adrenaline and this does not preclude referral.
Category 2 (appointment clinically indicated within 90 days)
- systemic reaction to insect venom, generalised rash and/or angioedema without respiratory/cardiovascular or gastrointestinal involvement
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.
- nature of bite/sting, type of insect including presence of stinger, if the insect is killed, keep and bring to consultation for identification
- previous stings/bites and nature of reaction
- comorbid conditions including asthma
- specific risk factors e.g. apiarist
- geographic location or geographic isolation
Additional information to assist triage categorisation
- if bloods are being done, please do total immunoglobulin E (IgE), specific IgE to causative insect and tryptase (all three are required)
- Honey Bee, Jack Jumper ant (SA Pathology only), European/common wasp, paper wasp venom. As guided by most likely cause of reaction
- family history of mast cell disorders
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
- develop an Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis and explain emergency management to patient
- educate on avoidance of allergen e.g. wearing shoes in summer, avoiding settings where bees are highly prevalent
- support parent in school/childcare communication
- ensure any asthma is well controlled
- general practitioner to ensure adrenaline autoinjector prescribed, and that family know how to use it
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.