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.

  • altered conscious state
  • severe hypoxia
  • uncontrolled hypercapnia

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 

Southern Adelaide Local Health Network

  • Flinders Medical Centre, request Respiratory Consults Registrar (08) 8204 5511

Exclusions

  • consideration of home oxygen in the following settings: 
    • current smokers or vaping*
    • dyspnoea in patients with PaO2 ≥ 60 mmHg or SpO2 ≥ 90% on room air
    • where therapy has not been fully maximised e.g. medication optimisation, pleural fluid aspiration, time for recovery from acute illness
    • cognitive or physical impairment that may compromise safety with oxygen therapy e.g. dementia, no home supports

*Please note assessment for oxygen therapy may be made 4 weeks after smoking cessation. Patients who are active smokers on admission to hospital will need to wait the full 4 weeks out of hospital before they would be considered for home oxygen. After the 4 weeks, the patient will need referral placed, with repeat arterial blood gas (ABG) and +/- urine cotinine/exhaled carbon monoxide (CO) to clarify their smoking status & determine eligibility for home oxygen.

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • consideration of home oxygen in the following settings
    • chronic (stable) hypoxaemia
    • acute unstable hypoxaemia
    • exertional hypoxaemia
    • nocturnal hypoxaemia
    • emergency use
    • palliative use

Category 2 (appointment clinically indicated within 90 days)

  • patients already on home oxygen requiring review

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.

  • primary diagnosis and comorbidities
  • smoking status, including pack years, date of cessation if relevant
  • hypercapnia - if yes, include partial pressure of carbon dioxide (PaCO2) on arterial blood gas (ABG)
  • details of any cognitive/physical limitations, if present
  • respiratory physician approval and details of oxygen prescription
    • liters per minute at rest/exercise/sleep
    • usage, hours per day
    • if relevant, oxygen flow rate during asthma (litres per minute (LPM)) via mask or nasal cannula

Indication for home oxygen

  • continuous oxygen therapy (18 to 24hrs/day)
    • specify if required for chronic stable hypoxaemia or unstable/acute hypoxemia
    • include results of arterial blood gas (ABG) on air (partial pressure of oxygen (PaO2), PaCO2) and LPM for oxygen, PaO2, PaCO2
  • intermittent oxygen therapy
    • specify if for exertional hypoxemia, nocturnal hypoxemia or emergency use
    • if exertional hypoxaemia, include results of 6-minute walk test
    • if nocturnal hypoxaemia, specify if requiring oxygen alone, or with nocturnal positive airway pressure (specify if continuous, bilevel or other), include overnight oximetry results (lowest oxygen saturation (SpO2), percentage time spent with SpO2< 90%)
    • if emergency use, specify if for acute asthma or other condition
  • palliative oxygen therapy for end-of-life illness with hypoxaemia - specify primary disease and respiratory complication, include results of ABG on air (PaO2, PaCO2) or if ABG not available/clinically inappropriate, SpO2 on room air

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number

Clinical management advice

Respiratory Physicians are the only medical team eligible to prescribe government funded home oxygen across South Australia. This applies to a patient's residence only, and is not applicable to aged care facilities, rehabilitation facilities, Transitional Care Packages, My Home Hospital and Hospital in the Home. Patients who are gold card Department of Veterans' Affairs (DVA) and are eligible, have their oxygen funded by DVA.

The conditions for ongoing funding for home oxygen therapy include Respiratory Specialist review within 4 to 6 weeks of initial oxygen prescription when the patient is in a stable condition, to determine ongoing oxygen requirement and then at least every 12 months thereafter. This appointment must be made by the referring medical team.

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.