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

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 – confirmed diagnosis
  • complex behaviour with associated medical diagnosis
  • fine motor problems – handwriting, cutting, manipulation and dexterity
  • gross motor problems – locomotor, ball skills, coordination, climbing, motor planning
  • sensory processing issues – sensitivities or sensory seeking behaviours
  • speech and language problems
  • suspected global developmental delay

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • child aged < 6 years with any of the following:
    • developmental regression
    • seizures
    • abnormal neurological features
    • significant co-morbidities

Category 2 (appointment clinically indicated within 90 days)

  • child aged less than 6 years with any of the following:
    • premature birth (less than 32 weeks gestation)
    • suspected autism spectrum disorder
    • moderate-severe developmental concerns
    • severe behavioural concerns – unable to attend childcare/school
    • at risk of physical harm or hurting others
    • investigated by child protective services
    • under the custody or guardianship of the Chief Executive

Category 3 (appointment clinically indicated within 365 days)

  • child with any of the following:
    • between 3 to 5 years of age and concerns of:
      • oppositional defiance disorder
      • autism spectrum disorder
      • hyperactive disorder
  • mild-moderate behavioural concerns engaged in community mental health/support programs

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 – please provide any relevant features as relating triage categories
  • family history, including family members affected with autism spectrum disorder (ASD), attention deficit hyperactive disorder (ADHD), learning difficulties or mental illness
  • medications and allergies
  • behaviours or other features identified by caregivers that have prompted referral request
  • physical examination findings
  • neurological examination findings

Concerning features

  • developmental regression
  • significant physical illness
  • unintentional weight loss
  • seizure or neurological features
  • functional impairment —  feeding, toileting or sleep issues
  • behaviours of concern including:
    • features of ASD
    • features of attention deficit
    • features of oppositional defiant disorder
    • potential for aggression

Additional information to assist triage categorisation

  • previous management trialled and outcomes
  • height/weight
  • body mass index (BMI) if child is aged ≥ 16 years
  • psychosocial factors — parental relationship issues, mental illness, substance abuse, parental disability, family in crisis, or child protection involvement
  • growth chart trends
  • blood pressure trends
  • visual acuity examination within last 6 months
  • audiometry examination findings
  • 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. The National Disability Insurance Scheme (NDIS) early childhood approach can facilitate and expedite community allied health involvement in children with suspected developmental disorders that are likely to require longer term input. Patients can self-refer or be referred by clinicians.

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.