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.

  • frequent falls
  • frequent/uncontrolled seizures
  • sudden onset weakness (hypotonia) with absent reflexes
  • sudden onset decreased neurological function
  • suspected raised intracranial pressure
  • thunderclap headache

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

Inclusions

  • attention deficit hyperactivity disorder
  • autism spectrum disorder ongoing management with confirmed diagnosis
  • complex behaviour with associated medical diagnosis
  • fine motor problems including handwriting, cutting, manipulation and dexterity
  • gross motor problems including locomotor, ball skills, coordination, climbing, motor planning
  • sensory processing issues (sensitivities or sensory seeking behaviours)
  • speech and language problems
  • suspected intellectual impairment

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • child with any of the following:
    • developmental regression — loss of previously acquired developmental skills
    • faltering growth
    • seizures or neurological signs, such as abnormal tone or power
    • suspected metabolic disorders

Category 2 (appointment clinically indicated within 90 days)

  • child with any of the following:
    • at risk of physical harm or hurting others
    • change in behaviour with a suspected medical or underlying developmental co- morbidity
    • investigated by child protective services
    • moderate-severe developmental concerns
    • premature birth less than 32 weeks gestation
    • severe behavioural concerns – unable to attend child care/school
    • severe behavioural concerns engaged in community mental health/support programmes
    • suspected autism spectrum disorder
    • under the custody or guardianship of the Chief Executive

Category 3 (appointment clinically indicated within 365 days)

  • child with any of the following:
    • oppositional defiance disorder
    • autism spectrum disorder
    • hyperactive disorder
    • mild-moderate behavioural concerns engaged in community mental health/support programmes

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, provide any relevant features as relating triage categories
  • medications and allergies
  • concerning features including,
    • developmental regression
    • significant physical illness
    • concurrent problems with weight or weight gain
    • seizure or neurological features such as abnormal tone or power
    • suspected metabolic disorders
    • functional impairment including feeding, toileting or sleep issues
  • behaviours of concern including
    • child with significant school refusal due to anxiety
    • exclusions, suspensions and expulsions
    • high-risk behaviours
    • potential for aggression
  • physical examination findings
  • developmental history including fine motor, gross motor, speech and social skills
  • neurological examination findings
  • visual acuity examination within last 6 months

Additional information to assist triage categorisation

  • current functional skills includin feeding, toileting or sleep issues
  • audiometry examination findings
  • psychosocial factors including parental relationship issues, mental illness, substance abuse, parental disability, family in crisis, or child protection involvement
  • previous management trialled and outcomes
  • height and weight
  • body mass index (BMI) if child is aged ≥ 16 years
  • growth chart trends
  • blood pressure trends
  • family history, including family members affected with autism spectrum disorder (ASD), attention deficit disorder (ADD), learning difficulties or mental illness
  • investigations if appropriate
    • genetic test screening
    • speech assessment
    • occupational assessment
    • physiotherapy assessment
    • psychology assessment
  • relevant allied health, diagnostic, imaging reports including location of company and accession number

Clinical management advice

We strongly suggest referrals are made to relevant allied health services (speech pathology, occupational therapy and physiotherapy), while awaiting paediatrician review.

Isolated speech and language delay, including simple consonant substitution or stuttering without red flags, will not be seen. We suggest referral to audiology and speech pathology if families have the financial resources to access these services.

  • Consider application for the National Disability Insurance Scheme (NDIS) if developmental delays are significant.
  • request learning assessment via school or private providers
  • consider application for carer’s allowance from Centrelink
  • consider referral to a private paediatrician

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.

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.