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.

  • extensive pemphigoid gestationis or blistering disorder of uncertain aetiology
  • erythroderma of any aetiology

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

  • any rash in pregnancy where the diagnosis is uncertain or rash is causing significant discomfort
  • severe exacerbations of pre-exiting dermatoses

Exclusions

  • cosmetic concerns e.g. linear nigra striae rubra

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • pemphigoid gestationis or blistering disorder of uncertain aetiology
  • severe polymorphic eruption of pregnancy or pruritic urticated papules and plaques of pregnancy (PUPPP). Severe is extensive in area, severe impact on quality of life, not responding to below general measures
  • generalised rash of uncertain aetiology

Category 2 (appointment clinically indicated within 90 days)

  • severe exacerbations of existing dermatoses not able to be managed in primary care e.g. atopic dermatitis, psoriasis, rosacea, acne

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.

  • gestation
  • past medical history
  • medications
  • pregnancy history
  • pregnancy providers

Clinical management advice

Exacerbations of acne can be managed initially with topical clindamycin and azelaic acid. Topical and oral retinoids must be avoided.

Exacerbations of eczema and psoriasis can be treated with short courses of topical steroids.

Polymorphic eruption of pregnancy (or pruritic urticated papules and plaques of pregnancy (PUPPP)) typically presents with an itchy red papular rash on the abdominal striae in the third trimester of the first pregnancy. It may spread to the trunk and proximal limbs. Polymorphic eruption of pregnancy usually resolves post-partum treatment may include the use of cool compresses, topical steroids, anti-histaminesmay need systemic steroids.

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.