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.

  • patient is acutely unwell (fever, tachycardia, altered mental state, rapid progression of infection, signs of necrosis) e.g. cellulitis and erysipelas
  • if the infection is serious e.g. suspected meningococcal disease, do not delay treatment with a broad-spectrum antibiotic, staphylococcal scalded skin syndrome

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

Northern Adelaide Local Health Network 

  • Lyell McEwin Hospital (08) 8182 9000, during business hours. After 5:00 pm contact either of the CALHN services. 

Southern Adelaide Local Health Network

Inclusions

  • patients with recurrent or complex bacterial infections if from Indigenous population or has comorbidities e.g. diabetes, immune suppressed, vascular insufficiency
  • furuncles, boils and abscesses

Exclusions

  • folliculitis, usually due to staphylococcus aureus, spa pool folliculitis from pseudomonas
  • erythrasma

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • patients with recurrent complex bacterial infections, if in one of the following categories
    • Indigenous population
    • has comorbidities e.g. diabetes, immune suppressed, vascular insufficiency

Category 2 (appointment clinically indicated within 90 days)

  • patients with recurrent, resistant, or complex bacterial infections

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.

  • past medical history, in particular diabetes mellitus, immune suppression e.g. transplant recipients
  • medication list
  • treatments trialled
  • microbiological investigations

Clinical management advice

  • consider seeking advice from Infectious Diseases prior to referring a bacterial skin infection to Dermatology
  • a skin swab may assist in confirming the diagnosis and a nasal swab may identify staphylococcus bacteria carriage.
  • if the patient is unwell, routine bloods and c-reactive protein (CRP) is advised
  • antibiotic resistance has increasing implications for the treatability and outcome of many bacterial skin infections. Topical antibiotics, such as fusidic acid, is generally discouraged; topical antiseptics are often used as an alternative for minor infections where topical mupirocin preferred over fusidic acid, as no systemic version of drug. More serious or persistent bacterial infections are treated with oral or intravenous antibiotics.
  • if infection is recurrent and treatment resistant e.g. MRSA, also consider Infectious Diseases review.

General management strategies

  • hand hygiene
  • lifestyle factors e.g. smoking cessation
  • optimising management of other medical conditions e.g. diabetic control
  • maintaining skin barrier e.g. through appropriate management of atopic dermatitis

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.