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 widespread blistering/pustular disease (greater than 10% denuded skin) e.g. drug eruptions, Toxic Epidermal Necrolysis (TEN), Stevens-Johnson syndrome, generalised pustular psoriasis
  • acute deterioration of a stable blistering/pustular disorder
  • cutaneous necrosis, where cause unknown
  • acute erythroderma in particular, if associated with haemodynamic or thermoregulatory complications

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

  • drug eruptions
  • vasculitic disorders including extensive purpura (vasculitis)
  • connective tissue disorders
  • photodermatoses
  • patients requiring complex drugs for management of dermatological skin disorders
  • complex drug-induced dermatoses
  • graft-versus-host disease (GvHD)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • vasculitic disorders including extensive purpura (vasculitis)
  • generalised drug-induced dermatoses
  • acute graft-versus-host disease (GvHD) i.e. greater than 100 days since allograft
  • neutrophilic dermatoses (pyoderma gangrenosum, Sweet syndrome)

Category 2 (appointment clinically indicated within 90 days)

  • the following conditions wherein greater than 10% body surface area is affected, topical therapy has been trialled for less than 3 months, and systemic options might be considered
    • drug eruptions
    • connective tissue disorders

Category 3 (appointment clinically indicated within 365 days)

  • photodermatoses

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.

  • reason for referral
  • occupation
  • duration of symptoms
  • relevant investigations, including pathology and imaging reports
  • past medical history including drug allergies
  • current medications, with start dates
  • provisional diagnosis
  • description of rash or lesion, include size, shape, location, colour and extent at minimum
  • treatment to date
  • any skin biopsy, swab/blood and allergy test results including attachment of pathology

Additional information to assist triage categorisation

  • colour photograph/s of lesion/s
  • consider performing biopsy if not already completed. Please contact relevant Local Health Network for further advice

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.