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.
- urosepsis
- acute infant urinary tract infection (UTI) unresponsive to first-line treatment
- concerns of severe UTI, symptoms may include
- ongoing persistent fever of 38° or higher
- persistent vomiting
- malodorous/cloudy urine
- serious dehydration
- hypertension greater than 97th percentile for age
- presumed UTI in infant less than 3 months of age and clinically unwell
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Exclusions
- concerns of ‘childhood non-accidental injury’ – refer to Child Protection Services for further information
- sexually transmitted infections – refer to Adelaide Sexual Health Centre
- no culture proven urinary tract infections (UTIs)
Triage categories
Category 1 (appointment clinically indicated within 30 days)
- infants aged 6 months of age with first presentation febrile UTI
- babies greater than 6 months of age and/or children with a history of acute pyelonephritis
- urosepsis in child with known significant renal tract abnormalities
- hydronephrosis with UTI
- concerns of bladder outlet obstruction
Category 2 (appointment clinically indicated within 90 days)
- child with a minimum of three UTIs within the last 12 months
- urinary tract infections with atypical bacteria
- known renal tract abnormality transfer of care
- infants and children with history of acute pyelonephritis/upper urinary tract infection post hospital admission without significant structural anomalies
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/developmental/immunisation history
- family history
- current medications
- allergies and sensitivities
- presenting symptoms history, including:
- onset
- duration
- frequency of urinary tract infections and age of first onset
- concerning features
- additional history of
- constipation
- fluid intake
- personal hygiene
- height/weight
- body mass index (BMI)
- growth chart trends
- blood pressure trends
- abdominal examination findings
- neurological examination findings
- assessment of central nervous system (CNS)/birth marks/dysmorphology
- bladder chart, intake/output fluid chart
- urinalysis (dipstick) result
- relevant diagnostic/imaging reports, including location of company and accession number
Pathology
- mid-stream urine (MSU) microscopy, culture and sensitivity (M/C/S)
- sexually active people – complete a sexually transmitted infection (STI) screen, including chlamydia and gonorrhoea which requires:
- endocervical/penile swab for culture and
- endocervical/penile polymerase chain reaction (PCR) swab or urine sample
Additional information to assist triage categorisation
- assessment of urinary stream
- pathology:
- complete blood examination (CBE)
- electrolytes, urea and creatinine (EUC)
- liver function test (LFT)
- estimated glomerular filtration rate (eGFR)
- c-reactive protein (CRP)
- kidneys, ureters, bladder (KUB) ultrasound (US) required for:
- child less than 12 months of age with first presentation urinary tract infection (UTI)
- children greater than 1 year of age with recurrent UTI’s or atypical UTIs
- quality of life concerns including missed work/school/extracurricular activities
Clinical resources
- National Institute for Health and Care Excellence - Urinary Tract Infection (Recurrent): Antimicrobial Prescribing
- Royal Children’s Hospital Melbourne – Paediatric Hypertension Guidelines
- Royal Children’s Hospital Melbourne – Urinary Tract Infection Clinical Guidelines
- South Australian Paediatric Clinical Practice Guidelines – Urinary Tract Infection (UTI) in Children (PDF 386KB)
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.