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.
- patients with suspected acute stroke or TIA should be referred to the nearest hospital and the referrer should dial 000 to activate the Code Stroke process which will facilitate timely care.
- ideally, the patient should attend a hospital with stroke services:
- Metropolitan Stroke Centres: Royal Adelaide Hospital, Flinders Medical Centre and Lyell McEwin Hospital
- Regional Stroke Units: Berri Hospital and Health Service, Mount Gambier and Districts Health Service and Whyalla Hospital and Health Service
- Country Stroke Thrombolysing services: Naracoorte Health Service, Port Pirie Regional Health Service, Wallaroo Hospital and Health Service, Port Augusta Hospital and Regional Health Service and Port Lincoln Health Service
- SA Telestroke Service is available 24/7 and can be reached by contacting the above hospitals
- it is recommended that you ask for the on-call stroke team when seeking emergent medical advice
- all patients with suspected stroke or TIA with symptom onset < 48 hours
- patients with suspected stroke associated with a significant functional deficit and symptom onset < 4 weeks
- patients with suspected minor stroke (minimal functional deficit) or TIA with symptom onset between 48 hours and 4 weeks ago should be referred to a TIA rapid assessment clinic or you may contact patient’s local health network on call stroke team for advice
- acute neurological symptoms which could be attributed to stroke or TIA include:
- facial droop
- unilateral limb weakness
- dysarthria (slurred speech)
- dysphasia (inability to speak)
- unilateral sensory loss
- acute onset vertigo (dizziness)
- acute onset ataxia (impaired balance or coordination)
- acute onset diplopia (double vision)
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
- Royal Adelaide Hospital (08) 7074 0000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Assessment of fitness to return to driving in the setting of persisting neurological or cognitive deficits after stroke – consider referral to a private occupational therapist or a public Driving Assessment Clinic. Country Referral Unit can provide advice for patients not within metropolitan Adelaide.
Patients with a remote history of stroke for general review or for optimising secondary prevention, unless a complex treatment dilemma has arisen – see Stroke Foundation Inform Me for up-to-date guidance on secondary prevention of stroke.
Patients with recent stroke who have had full diagnostic evaluation and appropriate therapy initiated.
Category 1 — appointment clinically indicated within 30 days
- recent new onset symptoms suggestive of stroke or TIA, without previous specialist review, not meeting criteria listed previously for TIA rapid assessment clinic or emergency department referral
Category 2 — appointment clinically indicated within 90 days
- patients requiring input regarding complex ongoing stroke-related management and prevention
- patients requiring ongoing management for:
- cerebral venous sinus thrombosis
- intracranial and extracranial arterial dissection
- cerebral amyloid angiopathy
- cerebral vasculitis causing stroke
Category 3 — appointment clinically indicated within 365 days
For information on referral forms and how to import them, please view general referral information.
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.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- complete past medical history
- current medication list including non-prescription medication, herbs and supplements
- alcohol and other drugs history
- relevant specialist medical reports and discharge summaries
- clinical history including:
- onset, duration and nature of symptoms
- degree of functional impairment
- completed investigations and current risk factor management
- non-contrast computerised tomography (CT) brain and computed tomography angiography (CTA) aortic arch to vertex
Additional information to assist triage categorisation
- complete blood examination (CBE)
- electrolytes, urea, creatinine (EUC)
- liver function tests (LFTs)
- estimated glomerular filtration rate (eGFR)
- fasting glucose and lipids
- glycated haemoglobin test (HbA1c)
- holter monitor (if completed)
- echocardiogram (Echo) (if completed)
- magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) intracranial and extracranial vessels where computed tomography angiography (CTA) is contraindicated
- if CTA contraindicated and MRA not accessible, a bilateral carotid duplex ultrasound (US) may be a useful alternative
- additional imaging may be arranged at the time of triage if not accessible prior to referral
- electrocardiogram (ECG)
Clinical management advice
Not all referrals require consultation with a neurologist and patients may be reviewed in advanced practice nurse led clinics where medically appropriate. Nurse led clinics are part of best evidence-based practice and have been shown to reduce patient wait times, increase consultation duration, increase patient engagement and satisfaction, improve communication and provide access to tailored advice on self-management of disease and illness.
Telehealth services are available for rural and remote patients requiring outpatient stroke and TIA services. Please mention in the referral if this is preferred for your patient.
If the patient you are referring requires urgent attention and/or fulfils category 1 triage criteria, it is strongly recommended that you contact the outpatient department to ensure your referral has been received.
Consider rehabilitation and allied health (physiotherapy, occupational therapy, speech therapy) management of symptoms due to previous stroke. Both private and public allied health options are available. For additional support in locating a suitable service in regional, rural and remote South Australia, contact the Country Referral Unit.
Consider whether your patient’s condition affects their fitness to drive as per Austroads Guidelines.
- SA Health - Stroke Management Procedures and Protocols (PDF 7109KB)
- Health Pathways SA - Transient Ischaemic Attack (TIA) (log in required)
- Health Pathways SA - Stroke (log in required)
- Stroke Foundation - Inform Me Clinician Resources
- Austroads - Fitness to Drive – Other Neurological and Neurodevelopmental Conditions