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.

  • collapse/seizure/altered level of consciousness/new acutely progressive neurological deficit

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • incidental, asymptomatic anatomical variants and expected degenerative changes

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • chiari malformation with hydrocephalus/syringomyelia confirmed with imaging
  • craniocervical junction abnormality with brain stem/spinal cord signal change confirmed with medical resonance imaging (MRI)
  • chiari malformation/craniocervical abnormality with sensory changes/weakness in the limbs/bladder or bowel dysfunction

Category 2 (appointment clinically indicated within 90 days)

  • abnormality of the craniocervical junction with concerning features, including:
    • abnormal reflexes
    • dizziness or vertigo
    • headaches, particularly in the back of the head
    • neck pain and stiffness

Category 3 (appointment clinically indicated within 365 days)

  • incidental chiari malformation without concerning features
  • craniocervical junction stenosis without concerning features

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.

  • relevant past medical/surgical history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
  • neurological examination findings
  • confirmation of diagnosis on imaging and associated reports including location, company, and accession number

Additional information to assist triage categorisation

  • medical resonance imaging (MRI) whole spine where possible to assess for presence of syrinx

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.