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.

  • urinary retention
  • severe pain
  • uncontrollable bleeding
  • systemic infection

Please contact the gynaecology 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

Women's and Children's Health Network

Exclusions

  • obstructive defecation associated with rectal prolapse – refer to colorectal

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • urinary retention
  • severe pain or bleeding associated with organ prolapse

Category 2 (appointment clinically indicated within 90 days)

  • difficulty voiding (half void) without renal impairment
  • post-void-residual of greater than 100mls without renal impairment

Category 3 (appointment clinically indicated within 365 days)

  • genitourinary prolapse
  • genitourinary incontinence
  • obstructive defecation associated with genitourinary prolapse

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

Due to limitations in infrastructure and resources, the Women's and Children's Hospital cannot accommodate referrals for individuals with a body mass index 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/psychosocial history
  • obstetric history
  • current medications and allergies
  • hormonal contraception use
  • onset, duration and course of presenting symptoms including,
    • difficulty with defecation requiring splinting or manual evacuation
    • micturition issues including stress/urge incontinence
    • fistula management/history
  • menstrual history:
    • cycle, day/months
    • days of bleeding
    • blood loss e.g. change of pads or tampons per day/hours
    • previously trialled treatments
  • pelvic examination findings
  • bladder diary including intake/output
  • pathology
    • mid-stream urine (MSU) microscopy, culture and sensitivity (M/C/S)
    • an up-to-date cervical screening test as per the cervical screening guidelines
  • relevant diagnostic/imaging reports including location of company and accession number
  • if major uterine procidentia (major pelvic organ prolapse) kidney/ureters/bladder ultrasound including post-volume residuals

Clinical management advice

This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened. Accessing a women's health physiotherapist can help with lifestyle advice and pelvic floor muscle exercises (and some fit support pessaries) to help manage prolapse conservatively.

Symptoms may include:

  • a feeling of a lump/ bulge in the vagina or coming out of the vagina
  • urinary:
    • slow urinary stream
    • incomplete bladder emptying sensation
    • frequency
    • urgency
    • urinary tract infection
    • stress incontinence
  • bowel:
    • difficulty with bowel motions
    • incomplete defecation sensation
    • needing to press on the vaginal wall to evacuate bowel (splinting)

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.