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.

  • all patients with suspected central cyanosis require an oxygen saturation check – this should ideally occur in the community clinic, however if unable to obtain oxygen saturation check, patient should present to emergency
    • in young infants, please also perform simultaneous pre and post ductal saturations, i.e. right arm and a foot
  • all patients with confirmed central cyanosis should present to emergency

Important: In the event of an emergency, or if there is concern regarding the patient’s condition deteriorating and safe transport, call 000 and arrange transfer via SA Ambulance Service.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Inclusions

  • all cases with suspected cardiac aetiology

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil – patients with central cyanosis should present to emergency

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Providing the following information will assist referral to Emergency Department:

  • clinical history including:
    • symptoms, including onset and duration, history of cyanosis (intermittent vs. persistent), areas involved e.g. perioral, peripheries, central (tongue and lips)
    • birth and perinatal history
    • growth, feeding history
    • other symptoms e.g. breathlessness, exercise tolerance, syncope
  • clinical examination findings e.g. clubbing, work of breathing, tachypnoea

Additional information to assist triage categorisation

  • electrocardiogram (ECG) and chest x-ray, if available
  • oxygen saturation, if available

Clinical management advice

Infants and pre-school children commonly have intermittent cyanosis involving the perioral area, lips, hands and feet, particularly at certain times, e.g. after a nap, after bathing, or when unwell. If colour resolves and nil other change in work of breathing or conscious state this is not likely to be related to cardiac pathology. If child is well without abnormal cardiac signs and this is intermittent no further action needs to be taken. If uncertain, oxygen saturations should be confirmed prior to referral.

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 role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) 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 referring clinician once the transfer of care has occurred.