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 cutaneous adverse reaction (SCAR) e.g.:
    • Stevens-Johnson Syndrome (SJS)
    • Toxic Epidermal Necrolysis (TEN)
    • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  • severe exfoliative or erythrodermic drug reactions
  • acute generalised exanthematous pustulosis (AGEP)
  • drug reaction with eosinophilia and systemic symptoms (fever, abnormal liver function tests)
  • 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
    • persistent abdominal pain, vomiting (signs of severe allergic reaction to drugs/ insects)
  • symptoms have required the administration of adrenaline

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

  • patients being treated for same condition at other hospital
  • non-allergic (not immune mediated) drug reactions
  • adverse reactions to drugs in keeping with known adverse reactions to the drug
  • referrals for drug de-labelling/drug allergy testing, refer to immunology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • when not requiring referral to emergency department, severe cutaneous adverse reaction (SCAR) e.g.
    • Stevens-Johnson Syndrome (SJS)
    • Toxic Epidermal Necrolysis (TEN)
    • Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  • exanthematous drug reactions
  • erythema multiforme major or minor
  • cutaneous vasculitis thought secondary to medication
  • urticarial vasculitis
  • urticaria directly related to medication

Category 2 (appointment clinically indicated within 90 days)

  • lichenoid drug eruption
  • fixed drug eruption
  • phototoxic or photoallergic drug reactions

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.

  • 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
  • past medical history, including asthma, and known prior drug allergies
  • type of reaction patient is presenting with e.g. morbilliform, severe cutaneous adverse reaction (SCAR)

Additional information to assist triage categorisation

  • advise patients to bring any photos of reaction to appointment
  • ensure that the drug history is well documented in the referral, including start and stop dates so that the most likely drug culprit/s can be identified

Clinical management advice

  • cease suspected drug
  • use alternative drug if available
  • inform patients of potential cross-reactivity including over the counter medications e.g. nonsteroidal anti-inflammatory drugs (NSAID) reactions
  • consider MedicAlert
  • update relevant medical records

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.