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 urinary retention
  • acute renal failure
  • acute/severe urinary tract calculi/colic with or without
    • urinary outlet obstruction
    • systemic signs of infection
  • severe and uncontrolled flank/back pain

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

For clinical advice, please telephone the relevant specialty service.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • outlet obstructive calculi/stone
  • proven calculi in ureter and any of the following:
    • decreased renal function and/or increasing pain
    • patients with single kidney and/or renal transplant
  • staghorn kidney stones
  • urinary tract calculi with urinary tract infections (UTIs)

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic renal calculi/stone greater than 5mm
  • bladder stone
  • confirmed calculi/stone in urinary tract and any of the following:
    • recurrent presentation
    • renal impairment
    • severe pain
    • unresponsive to first-line treatment

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.

  • past medical/surgical/psychosocial history e.g. known urinary tract anomalies
  • family history of:
    • stones, metabolic disease and renal failure
    • familial inherited disorders e.g. cystic fibrosis, Bartter’s, Lowe’s and Williams syndrome
  • current medications
  • allergies and sensitivities
  • presenting symptoms history, including:
    • age of first urinary tract infection (UTI)
    • onset/duration
    • frequency
    • diet/fluid intake history e.g. ketogenic diet, poor fluid intake
    • previous management trialled and outcomes
  • quality of life concerns including missed work/school/extracurricular activities
  • height/weight
  • body mass index (BMI)
  • growth chart trends
  • blood pressure (trends)
  • abdominal examination findings
  • bone structure
  • pre-natal and post-natal investigation summary
  • urinalysis (dipstick) result
  • bladder chart, intake/output fluid chart
  • pathology:
    • complete blood examination (CBE)
    • electrolytes, urea and creatinine (EUC)
    • liver function test (LFT)
    • estimated glomerular filtration rate (eGFR)
    • mid-stream urine (MSU) microscopy, culture and sensitivity (M/C/S)
  • kidneys, ureters and bladder (KUB) ultrasound (US) and x-ray
  • relevant diagnostic/imaging reports, including location of company and accession number

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.