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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • people with a physical and/or developmental disability or a complex medical condition with either of the following:
    • commenced menses and require assistance with menstrual management
    • pre-menarche: for discussion of menstrual management options

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/psychosocial history
  • current medications and allergies
  • menstrual history:
    • menarche
    • cycle, day/months
    • days of bleeding
    • blood loss e.g. change of pads or tampons per day/hours
    • previously trialled treatments
  • quality of life concerns including:
    • missed school/extracurricular activities
    • impact on family and support workers
    • behavioural changes or aggression
    • exacerbation of medical conditions e.g. increase in seizure activity
  • height/weight
  • BMI
  • growth chart trends
  • blood pressure
  • relevant physical examination findings

Clinical management advice

Initiating discussions about puberty and menstruation before menarche is the most beneficial approach.

Adolescents with disabilities or complex medical conditions may encounter extra difficulties and risks related to menstruation and pregnancy. These contributing risk factors may include:

  • physical health risks - depending on the nature of their disability or medical condition, adolescents may have pre-existing health issues that can complicate menstruation. In addition, hormonal changes during menstruation may worsen underlying medical problems.
  • medication interactions - some adolescents with disabilities or complex medical conditions may be taking medications that can have negative effects on menstruation. It is crucial to understand the potential risks and ensure appropriate management.
  • communication and understanding - adolescents with cognitive or intellectual disabilities may face challenges in comprehending reproductive health, menstruation, or sexual education. Providing adequate support and resources is vital to enable informed decision-making and understanding.
  • emotional and social factors - adolescents with disabilities or complex medical conditions, along with their families, may confront additional challenges regarding emotional well-being, social support, and coping with the physical demands of menstruation. In addition, hormonal changes during menstruation can worsen underlying behavioural problems.

Consulting specialist clinicians who work with people with disabilities, or complex medical conditions is essential for evaluating risks and providing appropriate management plans to address specific concerns related to menstruation management.

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.