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.

  • evidence of haemodynamic compromise
  • central cyanosis in a neonate
  • absent or reduced femoral pulses in a neonate

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

Inclusions

  • symptoms in infants:
    • pale grey or blue lips, tongue, or fingernails
    • rapid breathing
    • swelling in the legs, sacrum, or areas around the eyes
    • shortness of breath during feedings, leading to poor weight gain
    • sweaty/fatigues with feeds
  • symptoms of congenital heart defects in older children may include:
    • significant or worsening exertional dyspnoea syncope during exercise or activity
    • exercise intolerance
    • swelling in the hands, ankles or feet

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected congenital heart defect (CHD)
  • infant diagnosed with Trisomy 21 who has not had previous cardiac assessment

Category 2 (appointment clinically indicated within 90 days)

  • transfer of care, i.e. known to have CHD but now moved to South Australia, unless otherwise specified

Category 3 (appointment clinically indicated within 365 days)

  • routine follow-up for CHD

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.

  • clinical history including:
    • medical history including antenatal and perinatal history
    • clinical symptoms
    • details of any known cardiac conditions including past letters from cardiologist
    • family history of cardiac conditions
    • growth centiles
    • development
  • cardiac examination findings

Additional information to assist triage categorisation

  • oxygen saturations
  • electrocardiogram (ECG) and chest x-ray (CXR) if available

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.