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.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • infant with observed prolonged apnoeas

Category 2 (appointment clinically indicated within 90 days)

  • recurrent snoring with associated symptoms such as apnoeas, restless sleep, mouth breathing, daytime tiredness or headaches, poor concentration requiring objective evaluation to confirm the evidence of obstructive sleep apnoea 
  • recurrent snoring in children with risk factors for obstructive sleep apnoea e.g. obesity, hypotonia, facial dysmorphology, specific syndromes like Trisomy 21

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.

  • consider six-week trial of nasal steroids
  • current medication list including non-prescription medication, herbs and supplements

Examination

  • body mass index (BMI)
  • large tonsils
  • nasal obstruction
  • craniofacial abnormality
  • consider six-week trial of nasal steroids
  • current medication list including non-prescription medication, herbs and supplements

History

  • past medical/surgical history
  • onset, duration, and progression of symptoms, including:
    • parental observations and description of sleep patterns
      • snoring
      • restlessness
      • snorting arousals or apnoeic episodes
      • disturbed sleep, night terrors
      • enuresis, bruxism
    • daytime symptoms
      • hypersomnolence
      • irritability
      • hyperactivity
      • poor school performance
  • management history including treatments trialled/implemented prior to referral

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number
  • tonsillar hypertrophy grading scale

Clinical management advice

For clinical management advice regarding obstructive sleep apnoea/snoring - Ear, Nose and Throat CPC.

If a child has other sleep related concerns such as difficulty with sleep onset, frequent overnight awakenings, please consider techniques to improve sleep hygiene. If symptoms persist beyond 3 months, refer to Paediatric Respiratory & Sleep Medicine.

If child has unpleasant behaviours in sleep, e.g. night terrors, nightmares, sleepwalking, headbanging, bruxism, please ask if child has any recollections of such episodes to determine if these symptoms are occurring in the “awake” or “sleep” phase. If the child has no recollections of such episodes, reassure the family that these episodes are benign and improve beyond the preschool years.

If a child or adolescent has symptoms of excessive sleep, beyond normal standard hours for age group please refer to Paediatric Respiratory & Sleep Medicine.

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.