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.

  • nil

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

  • low immunoglobulin A (IgA) (in the presence of normal immunoglobulin G (IgG) and immunoglobulin M (IgM) levels) in the absence of clinical history suggestive of IEI, see 'essential referral information
    Human Immunodeficiency Virus (HIV) – refer to Infectious Diseases

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • high probability inborn error of immunity

Category 2 (appointment clinically indicated within 90 days)

  • low probability inborn error of immunity

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.

  • clinical history suggestive of an inborn error of immunity - warning signs include but are not restricted to
    • 8 or more new infections within one year
    • 2 or more serious sinus infections within one year
    • 2 or more months on antibiotics with little or no effect
    • 2 or more pneumonias within a year
    • failure of an infant to gain weight or grow normally
    • recurrent deep skin or organ abscesses
    • persistent thrush in the mouth or elsewhere on skin after age 1 year/persistent thrush in mouth or fungal infection on skin
    • need for intravenous antibiotics to clear infections
    • 2 or more deep-seated infections including septicaemia
    • a family history of immunodeficiency
    • 4 or more new ear infections within 1 year
  • history of recurrent/persistent, severe or unusual infections – date, type of infectious organism, severity, treatment trialled and response
  • features suggestive of immune dysregulation, including autoimmune manifestations, cytopaenia, splenomegaly, lymphadenopathy
  • family history
  • current management

Additional information to assist triage categorisation

  • full blood count (FBC) and differential, compare with previous results
  • blood film to assess for presence of Howell Jolly bodies
  • electrolytes, urea and creatinine (EUC)
  • liver function tests (LFTs) including albumin/protein
  • immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM)
  • lymphocyte subsets
  • complement component 4 (C4) level
  • chest x-ray
  • abdominal ultrasound

Clinical management advice

  • if there is a clinical suspicion of IEI, please contact the Immunology service, see ‘contacts for clinical advice’ for interim advice
  • IEI can be associated with serious morbidity and mortality, multiple admissions and significant risk if diagnosis is delayed
  • In the case of a child with suspected IEI presenting with features of infection, the following is recommended: clinical review, investigation for underlying infection and consideration of early treatment with antibiotic or other antimicrobial therapies as appropriate 
  • if there is concern for IEI, hold live attenuated viral vaccinations (including rotavirus, measles-mumps, rubella (MMR) and varicella) and other live vaccinations (including Bacille Calmette-Guerin (BCG)), pending specialist assessment

Clinical 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.