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.

  • acute presentation of syncope with exertion

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Inclusions

  • exercise intolerance with:
    • a history of syncope during exertion
    • abnormal clinical cardiac findings
    • known congenital heart defect (CHD)
    • a family history of inherited cardiac arrhythmia, cardiomyopathy or sudden death in the young
  • progressive exercise intolerance with abnormal cardiac findings, e.g. clinical examination, electrocardiogram (ECG) or chest x-ray (CXR) findings

Exclusions

  • general fatigue or tiredness without abnormal cardiac findings on clinical examination, electrocardiogram (ECG) or chest x-ray (CXR) - refer to Paediatric Medicine

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • exercise intolerance with:
    • previous syncope during exertion
    • abnormal clinical cardiac findings

Category 2 (appointment clinically indicated within 90 days)

  • exercise intolerance with a family history of inherited cardiac arrhythmia, cardiomyopathy or sudden death in the young
  • exercise intolerance with chest pain on exertion
  • exercise intolerance in patient with known congenital heart defect (CHD)
  • progressive exercise intolerance with abnormal cardiac findings, e.g. clinical examination, electrocardiogram (ECG) or chest x-ray (CXR) findings

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.

  • clinical history including:
    • description of exercise intolerance, and change over time
    • associated symptoms
    • past medical history
    • family history
    • growth centiles
  • findings on clinical examination, including observations

Additional information to assist triage categorisation

  • electrocardiogram (ECG)/chest x-ray (CXR) report or image, if available
  • oxygen saturations

Clinical management advice

Exercise intolerance is a common, non-specific, presenting symptom in young people. It can be useful to obtain collateral history, e.g. from school/co-curricular activities to assess significance.

Consideration of bloods, e.g. full blood count (FBC), iron, vitamin D, thyroid function test (TFT), for other causes of exercise intolerance.

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.