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 uncontrolled asthma
  • acute exacerbation of asthma not responding to therapy
  • asthma with any of the following concerning features
    • coexistent pneumothorax
    • pneumonia
    • signs of respiratory distress
    • if the patient has a silent chest, cardiovascular compromise, relative bradycardia or decreasing rate and depth of breathing, these are all signs of an impending respiratory arrest and require urgent medical attention
  • respiratory distress leading to
    • apnoeic episode
    • cyanosis
    • dyspnoea
    • intercostal or subcostal retractions
    • tracheal tug
    • inability to feed or sleep in an infant
    • episodic vomiting after feeding or coughing
    • stridor
  • haemodynamic instability

Please contact the paediatric medicine on-call registrar or relevant surgical or medical subspecialty to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Asthma Australia

  • 1800 ASTHMA (1800 278 462) 8:30 am to 4:30 pm, Monday to Friday

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • asthma without first-line management in alignment with the Australian Asthma Handbook
  • bronchiolitis – refer to emergency department if concerns of respiratory distress
  • difficult to manage or diagnostically uncertain asthma presentations, refer to respiratory and sleep medicine

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • refractory asthma despite inhaled corticosteroid use and asthma management plan, but not requiring more than 250mcg fluticasone propionate

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.

  • past medical history, please provide any relevant features as relating to triage categories
  • history of infections including:
    • severity and frequency of episodes
    • length of stay and number of admissions to hospital
    • triggers for episodes — viral, allergic rhinitis if relevant
    • current management regime if appropriate
    • treatments trialled and response to interventions - Australian Asthma Handbook
    • additional medical specialist involvement if appropriate
  • respiratory examination findings
  • height and weight

Additional information to assist triage categorisation

  • family history of asthma, atopy or cystic fibrosis
  • body mass index (BMI) in children aged ≥ 16 years
  • growth chart trends
  • spirometry in children aged greater than 6 years
  • chest x-ray where clinically indicated
  • pathology:
    • nasopharyngeal aspirate polymerase chain reaction (PCR) where relevant
    • sputum microscopy, culture and sensitivity (MCS). Identify if currently taking antibiotics when specimen is obtained
  • relevant discharge summaries, diagnostic, imaging reports including location of company and accession number

Clinical management advice

In children aged less than 12 months, consider other diagnoses as asthma is less likely and management is unlikely to be of benefit. Children with allergic rhinitis and asthma benefit from a comprehensive approach to symptom management. This may include allergen avoidance strategies, and inhaled corticosteroids to control the inflammatory response. Proper management can significantly improve the quality of life and reduce the frequency and severity of symptoms and is effectively completed in the community with General Practitioners.

Bronchiolitis is a common viral respiratory condition predominantly affecting infants less than 12 months of age. It is typically self-limiting, with symptoms peaking around day two to three and resolving over 7 to 10 days. Management primarily revolves around supportive care, and most cases do not require specific medical interventions. The provided resources and clinical guidelines should be followed for all presentations.

Clinical resources

Asthma

Bronchiolitis

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.