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.

  • Staphylococcal Scalded Skin Syndrome
  • Vellulitis
  • eczema herpeticum
  • shingles
  • Streptococcal Toxic Shock Syndrome (STSS)
  • any patient with suspected infectious skin disease who is systemically unwell

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

  • impetigo
  • methicillin-resistant staphylococcus aureus (MRSA), may also be referred to Infectious Diseases
  • warts in an immunocompromised patient
  • molluscum contagiosum in a patient who is immunocompromised patient, or has complex medical issues
  • warts (viral verruca) in a patient who is immunocompromised patient, or has complex medical issues
  • recurrent folliculitis, if occurring in body flexures, consider whether this is Hidradenitis Suppuritiva
  • tinea capitis/kerion
  • confirmed onychomycosis
  • candidal skin infections
  • scabies and post scabetic itch which has not responded to treatment in primary care

Exclusions

  • unexplained lymphadenopathy
  • simple skin infections for which first-line therapies have not yet been trialled
  • uncomplicated molluscum contagiosum
  • uncomplicated warts (viral verruca)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • recurrent skin infections affecting function/not responding to first line therapies leading to scarring/alopecia

Category 3 (appointment clinically indicated within 365 days)

  • recurrent skin infections affecting function/not responding to first line therapies

Additional information to assist triage categorisation

  • provide details of previous swab results, skin/hair scrapings and detail previous therapies including specific medication, dose and duration of therapy
  • consider undertaking swabs of nares and if positive for staphylococcus, undertaking decolonisation of patient and close contacts, see Staphylococcus aureus Decolonisation – Paediatric (PDF 270KB) for instructions

Clinical management advice

Impetigo

  • using a clean warm flannel, soak off yellow crusts four times a day and apply Bactroban ointment twice daily to areas of involvement
  • if more widespread impetigo, consider using cephalexin or flucloxacillin, dosed according to the child’s weight

Tinea capitis

  • take a hair pluck and scraping of skin to confirm diagnosis and fungal species
  • empirical therapy is terbinafine 250mg (child less than 20kg: 62.5mg; child 20-40kg: 125mg) orally, once daily for four weeks
  • if Microsporum species if identified, consider switching to Griseofulvin if the patient is not responding (griseofulvin 20mg/kg (up to 500mg) orally, once daily for 6-8 weeks
  • repeat culture at the end of treatment (stop therapy when the culture is negative and hair has regrown.

Warts

  • salicylic acid up to 40% w/v, with or without lactic acid, topically, once daily until wart has cleared or for up to three months
  • avoid trauma to the wart, as patients may auto-inoculate, spreading warts
  • keep nails short to prevent auto-inoculation, or spreading to close contacts

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.