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/severe pelvic pain
  • significant or uncontrolled vaginal bleeding
  • severe infection
  • ascites resulting from known malignancy
  • urinary retention resulting from known malignancy
  • acute urinary obstruction resulting from known malignancy

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • cervical cancer
  • ovarian cancer
  • people with high-risk presentation due to Risk of Malignancy Index (RMI) or International Ovarian Tumour Analysis (IOTA) classification
  • uterine/endometrial cancer
  • vaginal cancer
  • vulvar cancer

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • nil

All referrals for people less than 16 years of age, or those less than 18 years with intellectual disabilities, complex medical conditions, primary amenorrhea, pubertal delay, or Mullerian anomalies are to be sent to Women’s and Children’s Hospital (WCH).

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the WCH cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

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.

  • past medical/surgical/obstetric/psychosocial/vaccination history
  • family history where relevant
  • menstrual history:
    • cycle, day/months
    • days of bleeding
    • blood loss
  • current medications and allergies, including hormonal contraception use
  • onset, duration and course of presenting symptoms/red flags
  • physical examination
    • height/weight
    • BMI
    • pelvic examination findings
  • pathology:
    • complete blood examination (CBE)
    • beta human chorionic gonadotropin (ßhCG)
    • an up-to-date cervical screening test as per the cervical screening guidelines/Co-Test
  • confirmation diagnostic pathology, reports, and imaging including location of company and accession number
  • computed tomography (CT) chest-abdomen-pelvis (CAP)

If ovarian cancer

  • cancer antigen 125 (CA125)
  • cancer antigen 19.9 (CA19.9)
  • carcinoembryonic antigen (CEA)

Women less than 35 years of age

  • alpha-fetoprotein (AFP)
  • lactate dehydrogenase (LDH)

If vulval cancer

  • biopsy of lesion, this should not delay referral if clinical suspicion is high.

Clinical management advice

Vulval cancers may present as unexplained lumps, bleeding from ulceration or pain. Vulval cancer may also present with pruritus or pain. For a patient who presents with these symptoms and where cancer is not immediately suspected, it is reasonable to use a period of ‘treat, watch and wait’ as a method of management.

This should include active follow-up until symptoms resolve or a diagnosis is confirmed. Refer if unexplained symptoms persist.

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.

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 General Practitioners role 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 General Practitioner once the transfer of care has occurred.