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/altered level of consciousness/new neurological deficit/seizures
  • bulging fontanelle +/- prominent veins on head
  • sunsetting eyes

Please contact the 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.

Women's and Children's Health Network

Exclusions

  • asymptomatic children > 2 years of age with a head circumference greater than the 98th centile with no history of crossing > 2 centile lines or disproportionate to other growth parameters
  • children > 2 years of age with a head circumference greater than the 98th centile and developmental delay or neurological deficits without radiological intracranial abnormality should be referred to paediatric neurology services at Southern Adelaide Local Health Network or Women’s and Children’s Health Network

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • children < 2 years of age without concerning features and head circumference that crosses 2 or more centile lines

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic children > 2 years of age with a head circumference greater than the 98th centile with history of crossing > 2 centile lines or disproportionate to other growth parameters

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.

  • child/parent’s demographic information including best contact details
  • past medical/surgical history
  • current medications, allergies

History of presenting complaint including:

  • onset
  • duration
  • concerning features
    • developmental delay
    • regression in developmental milestones
    • papilledema
    • irritability / behavioural changes
  • treatments trialled/implemented prior to referral
  • head circumference measurements at birth and at time of assessment
  • growth chart trends including head circumference
  • neurological examination findings
  • in children greater than 2 years of age or with closed anterior fontanelle brain computed tomography (CT)
  • in children less than 2 years of age and/or with open anterior fontanelle ultrasound (US) head
  • confirmation of diagnosis on imaging and associated reports including location, company, and accession number

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.