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.

  • abdominal distention
  • bilious (green) vomiting
  • focal tenderness/guarding
  • foreign substance/body ingestion
  • gastric outlet obstruction
  • haemodynamic instability
  • ingested caustic and acid substances
  • inguinal/scrotal pain or swelling
  • overt rectal bleeding
  • peritonism
  • respiratory distress/stridor
  • severe/uncontrollable abdominal pain
    • localised tenderness/guarding
  • severe diarrhoea and/or vomiting with symptoms of dehydration
  • suspected appendicitis
  • suspected intussusception

Please contact the paediatric medicine on-call registrar (or relevant surgical or medical subspecialty) to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Regional Health Networks 

Eyre and Far North Local Health Network

Flinders and Upper North Local Health Network

Limestone Coast Local Health Network

Exclusions

  • strong clinical suspicion of inflammatory bowel disease (IBD) or other condition likely to require endoscopy or colonoscopy, refer to Gastroenterology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recurrent/chronic abdominal pain with concerning features such as:
    • bloody stools
    • clubbing of fingers/toes
    • dysphagia
    • faltering growth (failure to thrive)
    • persistent fever
    • joint pain
    • mouth ulcers
    • persistent vomiting
    • skin rash
    • unexplained anaemia, asymptomatic Hb less than 85g/L
    • unintentional weight loss
  • suspected malignancy, please contact paediatric medicine registrar on-call to discuss your concerns prior to referral
  • at least 50% unattendance to school, work, extracurricular activities

Category 2 (appointment clinically indicated within 90 days)

  • recurrent or chronic diarrhoea without concerning features

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.

  • past medical history, providing any relevant features as relating triage categories
  • medications and allergies
  • presenting symptoms including:
    • dates and frequency of symptoms
    • duration and severity of episodes
    • treatment trialled and response
    • current management regime including medications, and allied health input
    • medical specialist involvement if previous medical consultation completed
  • abdominal examination findings
  • height and weight

Additional information to assist triage categorisation

  • family history of autoimmune disease, inflammatory bowel disease, immunodeficiency syndromes
  • menstrual history, if relevant
  • sexual history, if relevant
  • toileting history including stool chart
  • body mass index (BMI) if child is aged ≥ 16 years
  • growth chart trends
  • blood pressure trends
  • allied health reports/summaries
  • pathology:
    • complete blood examination (CBE)
    • urea, electrolytes, creatinine (UEC)
    • liver function tests (LFTs)
    • c-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • iron (Fe) studies
    • coeliac serology
    • urinalysis
    • faecal calprotectin
    • faecal multiplex polymerase chain reaction (PCR)
    • stool microculture and sensitivities (M/C/S)
  • fructose/lactose breath hydrogen testing
  • abdominal ultrasound (US)
  • relevant diagnostic/imaging reports including location of 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.