​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • epiglottitis or bacterial tracheitis
  • haemorrhagic tonsillitis
  • peritonsillar cellulitis or abscess
  • severe dehydration
  • swelling causing acute upper airway obstruction (for example stridor or respiratory distress)
  • toxic appearance (for example pale or mottled skin, cool extremities, weak cry, grunting, rigors, decreased responsiveness, or signs of sepsis in children)
  • unable to tolerate oral intake.

When public outpatient services are not routinely provided

  • Enlarged tonsils with no recurrent tonsillitis as described in Category 2 and 3 criteria, and/or no evidence of obstructive sleep disordered breathing.
  • Recurrent tonsillitis where episodes are fewer than described in Category 2 and 3 criteria, and no modifying factors are present.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Suspected malignancy.
  • Abnormally appearing tonsils with any of the following present:
    • drenching night sweats in the absence of infection
    • unexplained weight loss (> 10% of body weight over 3 months).

Category 2
Recommended to be seen within 90 calendar days.

  • Ulceration and/or recurrent u​​nilateral enlargement, with or without lymphadenopathy.
  • Complicated tonsillitis (for example multiple medication allergies).
  • ≥ 1 episode of quinsy in the context of recurrent tonsillitis.
  • ≥ 2 episodes of quinsy without a history of recurrent tonsillitis.
  • Severe complications associated with infection (for example febrile convulsion, neurological sequelae).

Category 3
Recommended to be seen within 365 calendar days.

  • Recurrent tonsillitis with:
    • ≥ 7 episodes in the last 12 months
    • ≥ 4 - 5 episodes per year in the last 24 months
    • ≥ 3 episodes per year in the last 36 months.
  • Episodes of acute tonsillitis are significantly affecting schooling or employment.
  • Associated signs of sleep disordered breathing (for example abnormal respiratory patterns including presence of apnoea or hypopnoea, snoring, restless sleep).
  • Swallowing difficulties causing pathological weight loss.
  • Recurrent tonsillitis associated with PANDAS, PFAPA and/or Aphthous stomatitis for consideration for tonsillectomy.
  • Gagging of food.
  • Tonsil stones and/or halitosis.

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition, including number, timeframe and severity of previous episodes of quinsy and acute tonsillitis.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:.
    • Medical management to date.
    • Time off school or work.
    • Symptoms of obstructive sleep apnoea.

If available

  • Epstein-Barr virus (EBV) serology or monospot results.
  • Full blood count (FBC) results.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ or among a vulnerable, disadvantaged or priority population.
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Monday 17 June 2024
Contact page owner: System Purchasing