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.

  • developmental, cognitive, psychiatric regression accompanying new onset, or ongoing epileptic seizures
  • epileptic seizure in babies < 12 months of age
  • new onset seizure with concerning features including:
    • cognitive impairment
    • focal weakness
    • requiring emergency support
    • speech impairment
  • ongoing convulsive or non-convulsive seizure activity
  • recurrent seizures (> 5) commencement of anti-epileptic drugs
    • excluding typical absence seizures
  • sudden onset decreased neurological function
  • suspected raised intracranial pressure
  • specific seizure types with risk of epileptic encephalopathy — infant with possible epileptic spasms

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

  • electroencephalogram (EEG) requests, refer to neurophysiology for assessment
  • complex and/or intractable seizure disorders – refer to Neurology
  • simple febrile seizures

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected/confirmed epilepsy with any of the following:
    • abnormal neurological examination with features of ataxia or dysarthria
    • focal epilepsy greater than once per month before commencement of anti-epileptic medication
    • high-risk glucose transporter disorder
    • in a child greater than 2 years of age
    • increasing head circumference (crossing centiles)
    • menstrual cycle related tonic/clonic seizures with frequency greater than once a month
    • milestone regression
    • refractive epilepsy
    • suspected epilepsy syndrome
    • uncontrolled seizures/events greater than once per month

Category 2 (appointment clinically indicated within 90 days)

  • suspected or confirmed epilepsy with any of the following:
    • focal epilepsy less than once per month before commencement of anti-epileptic medication
    • for which specific treatment/referral path may be indicated
    • in a child greater than 2 years of age
    • menstrual cycle related tonic/clonic seizures with frequency less than once a month
    • normal neurological examination
    • uncontrolled seizures/events less than once per month

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, provide any relevant features as relating triage categories
  • medications and allergies
  • presenting symptoms/features including:
    • loss of consciousness/awareness
    • cyanosis
    • injuries
    • frequency of use of emergency services
    • medication/s
  • duration and onset of symptoms
  • frequency of events, episodes, witnessed, unwitnessed
    • post ictal response and duration
  • previous management trialled and outcomes including current and past medications used to control epilepsy
  • height/weight
  • neurological examination findings

Additional information to assist triage categorisation

  • body mass index (BMI) if child is aged ≥ 16 years
  • growth chart trends
  • smoking/alcohol and other drug status
  • electrocardiogram (ECG)
  • electroencephalogram (EEG)
  • pathology
    • antiepileptic drug level/s
  • allied health assessments and reports
  • relevant diagnostic and imaging reports including location of company and accession number

Clinical management advice

Please note that two separate referrals are required – electroencephalogram (EEG) and for specialist assessment (paediatric medicine vs. paediatric neurology pending circumstances). 

To refer:

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.