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.

  • >any new mass/lesions leading to respiratory/cardiovascular/feeding compromise

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


Inclusions

  • new pigmented lesions
  • enlarging masses /lesions unable to be categorised in primary care

Exclusions

  • lesions with secondary infection/leading to systemic compromise, send to emergency department

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • new enlarging pigmented lesion
  • new enlarging vascular lesion affecting function/in cosmetically sensitive area
  • rapidly growing skin lesion

Category 2 (appointment clinically indicated within 90 days)

  • slowly-changing birthmark/pre-existing lesion
  • new lesions not able to be categorised by primary care physician e.g. juvenile xanthogranuloma, spitz naevus, mastocytoma

Category 3 (appointment clinically indicated within 365 days)

  • nil

Additional information to assist triage categorisation

  • any effect on function
  • please send photos if possible

Clinical management advice

  • paediatric melanoma is extremely rare
  • congenital and acquired pigmented lesions in children and adolescents should be identified early and the intensity of surveillance dictated by the risk of malignant transformation.
  • a history of ultraviolet (UV) exposure, a family history of melanoma, and the presence of dysplastic naevi should alert GPs to a risk of melanoma, even in children and adolescents.

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.