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 abdominal pain/shock

Please contact the gynaecology 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.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • implanon removal

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • intrauterine contraceptive device (IUCD) intra-abdominal - location confirmed on imaging

Category 2 (appointment clinically indicated within 90 days)

  • IUCD embedded in the myometrium - location confirmed on imaging

Category 3 (appointment clinically indicated within 365 days)

  • IUCD strings not visible - location confirmed on imaging

All referrals for people less than 16 years of age, or those less than 18 years with intellectual disabilities, complex medical conditions, primary amenorrhea, pubertal delay, or Mullerian anomalies are to be sent to Women’s and Children’s Hospital (WCH).

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the WCH cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

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/obstetric/psychosocial history
  • current medications and allergies
  • hormonal contraception use
  • onset, duration and course of presenting symptoms/attempts made to remove the device
  • menstrual history:
    • cycle day/months
    • days of bleeding
    • blood loss e.g. change of pads or tampons per day/ hours
    • previously trialled treatments
  • height/weight
  • body mass index (BMI)
  • pelvic ultrasound (US) confirming the location
  • abdominal x-ray, device location not confirmed on US

Sexually active people

Complete a sexually transmitted infection (STI) screen, including:

  • human immunodeficiency virus (HPV) and syphilis serology
  • chlamydia and gonorrhoea which requires:
    • endocervical swab for culture and
    • endocervical polymerase chain reaction (PCR) swab or urine sample

Clinical management advice

If you have concerns that the contraceptive device is not appropriately located please ensure an alternative form of contraception is commenced.

Complicated intrauterine contraceptive device (IUCD) removal is defined as:

  • strings not visible
  • device suspected to be embedded in the myometrium
  • intra-abdominal device

Implanon insertion removal is defined as:

  • inability to clinically locate device on palpation

Many private radiology practices offer complicated implanon device removal in the community, although they may charge a fee (gap) for this service. It is advisable to contact your preferred radiology service for further information.

The outpatient hysteroscopy service at Modbury Hospital offers a ‘see and treat’ option for removing IUCD where the strings are not visible. Please contact the gynaecology outpatient service for further information.

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.