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.

  • concerns for infection including septic arthritis
  • complications of disease or therapy requiring emergent review – systemically unwell

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • increasing frequency of episodes for an established autoinflammatory condition, escalating symptoms or significant effect on quality of life
  • evidence of new autoinflammatory disease including periodic fevers without evidence of infection
  • evidence of organ compromise such as neurological involvement or renal compromise secondary to underlying autoinflammatory condition

Category 2 (appointment clinically indicated within 90 days)

  • suspected periodic fever syndromes
  • stable symptoms thought to be related to periodic fever syndrome

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.

  • physical examination including description of rashes, pharyngitis, lymphadenopathy, hepatosplenomegaly, arthritis
  • ethnicity
  • family history of periodic fever or autoinflammatory diseases, renal involvement, and deafness

History of fevers

  • duration of fevers
  • frequency
  • number of episodes of fever
  • responses to medications including steroids if trialed
  • age of onset of fevers

History of presenting complaint

  • symptoms: rash, mouth ulcers, pharyngitis, joint pain and swelling, abdominal or chest pain, diarrhoea, or constipation

Additional information to assist triage categorisation

  • past medical history
  • medication history
  • any blood tests, urine samples or viral swabs if available
  • relevant diagnostic/imaging reports including location of company and accession number
  • fever diary documenting duration of fever and associated symptoms
  • any photos of rashes, suggest to families to take photos of any rashes and bring these to outpatient appointment

Clinical management advice

Children with autoinflammatory diseases may be seen by both rheumatology and allergy and immunology services. Preferential referral to allergy and immunology is recommended where an immunodeficiency disease / inborn error of immunity is amongst differentials.

  • symptomatic management of febrile episodes with simple analgesia
  • generally no other specific management is required prior to review in rheumatology clinic

Clinical 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.