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.

  • sudden onset facial weakness with:
    • otorrhea and otalgia
    • trauma
    • associated neurological signs indicating neurological event – patients with suspected acute stroke or transient ischaemic attack (TIA) should be referred to the nearest hospital and the referrer should dial 000 to activate the Code Stroke process which will facilitate timely caresevere or persistent epistaxis

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • acute facial nerve palsy unresponsive to treatment
  • lower motor neuron palsy and any of the following:
    • hearing loss
    • suspected other cranial nerve involvement
    • otalgia and/or otorrhoea
    • parotid mass
  • perineural spread from cutaneous squamous cell carcinoma with or without sensory changes e.g. tingling, numbness

Category 2 — appointment clinically indicated within 90 days

  • progressive facial weakness

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.

  • history of presenting complaint including duration length and symptoms
  • details of previous medical management including:
    • systemic and topical medications prescribed
    • duration and outcome of the treatment
  • neurological assessment/history
  • relevant reports and results

Additional information to assist triage categorisation

  • fine cut/slice high-resolution computerised tomography (HRCT) temporal bone including company and accession number
  • tomography (HRCT) temporal bone including company and accession number
  • diagnostic audiology report is highly desirable where available and not cause significant delay

If facial palsy with otalgia and otorrhoea, consider fine cut/slice high-resolution computerised tomography (HRCT) scan of temporal bone to rule out cholesteatoma.

Initiate medical management

  • oral prednisolone 1mg/kg daily for five days (maximum dose 80 mg per day)
  • consider oral antivirals - if indicative of Ramsay Hunt syndrome
  • eye protection from corneal abrasion e.g. lacrilube and tape eye shut nocte
  • consider speech pathology assessment if speech and/or swallowing affected
  • arrange diagnostic audiological assessment

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.