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.

  • call respiratory/sleep registrar on call for advice if needed

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

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre, request Respiratory Consults Registrar (08) 8204 5511

Inclusions

Suspected or confirmed clinical disorders

  • excessive daytime sleepiness (people who cannot stay awake) in the absence of readily identifiable factors, e.g. use of sedating medications, presence of environmental or lifestyle factors preventing adequate quality and/or quantity of sleep, poor sleep-wake hygienee.g. Narcolepsy, Idiopathic Hypersomnia
  • circadian rhythm sleep-wake disorder (people who are not sleeping at the right time)e.g. Delayed Sleep Phase Syndrome, Shift Work Disorder
  • chronic primary insomnia (people who cannot sleep at night)
    • difficulty initiating or maintaining sleep lasting > 3 months, not associated grieving or severe and/or unstable psychiatric illness
  • parasomnia (people who behave abnormally during sleep)e.g. sleep-walking or sleep-eating, rapid eye movement (REM) Behaviour Disorder, severe nightmares not related to psychiatric illness or post-traumatic stress disorder (PTSD)
  • sleep-related movement disorders (people who exhibit abnormal movements during sleep or close to sleeping time) e.g. Restless Legs Syndrome

Exclusions

  • suspected or confirmed non-respiratory sleep disorders in the presence of, or driven by, severe and/or unstable psychiatric disorder(s) illness including psychosis, major depression, or post-traumatic stress disorder, or in the presence of substance abuse or polypharmacy with sedating medications.

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • road crash or work-related accident or near miss accident due to excessive sleepiness within the last 12 months
  • dozing at the wheel > once per month
  • Epworth Sleepiness Scale (ESS) score > 16
    • Rapid excess for sleepy patients holding safety critical occupation
  • pregnancy

Category 2 (appointment clinically indicated within 90 days)

  • suspected or confirmed non-respiratory sleep disorder with any of the following:
    • road crash or work-related accident or near miss accident due to excessive sleepiness within the last 5 years but not within the last 12 months
    • dozing at the wheel within the last 12 months and no more than once a month
    • Epworth Sleepiness Scale (ESS) score 10 to 15
    • patients holding safety critical occupation
  • suspected or confirmed Narcolepsy or Idiopathic Hypersomnia, regardless of the above
  • suspected parasomnia or sleep related movement disorder with risk of significant harm to self or others, regardless of the above. This may qualify for category 1 depending on the risk of harm to self or others

Category 3 (appointment clinically indicated within 365 days)

  • suspected or confirmed sleep disordered breathing not meeting indication for emergency presentation, category 1 or category 2, but still require specialist respiratory/sleep clinic review

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.

Triaging information

  • specify urgency (category 1, 2 or 3) according to triaging criteria
  • Epworth Sleepiness Scale (ESS) score
  • occupation
  • history of road crash or work-related accident or near miss accident due to sleepiness, including date, if relevant
  • frequency of dozing at the wheel, if relevant
  • reports of previous sleep and respiratory investigations if available

Suspected/confirmed non-respiratory sleep disorder

  • duration, frequency and severity of symptoms
  • treatment to date and response/outcome

Relevant other clinical information

  • body mass index (BMI)
  • significant co-morbidities including mental health, cardiac, neurological, neurodegenerative, respiratory and non-respiratory sleep disorders
  • current medications
  • blood panel report if available, e.g. full blood count (FBC), electrolytes and renal function, thyroid function test and fasting iron studies (for Restless Legs Syndrome)

Additional information to assist triage categorisation

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

Clinical management advice

Scope of investigations/treatment/management provided:

  • diagnostic work-up
  • implementation of treatment, optimisation and supervision of therapy where care cannot be provided by a general practitioner alone
  • specialist management of non-respiratory sleep disorder, including those with:
    • a history of road or work-related accident or near miss accident due to excessive sleepiness regardless of type of occupation
    • safety critical occupation, e.g. commercial drivers, operators of heavy machinery
    • intractable symptoms
  • multi-disciplinary management including access to sleep psychiatry and/or clinical sleep psychology teams

Referring doctor responsibilities

The referring doctor is responsible for:

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.