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

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

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.

Triage categories

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

  • 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.

  • 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.

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.