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.

  • severe symptomatic anaemia with:
    • acute overt gastrointestinal bleeding
    • chest pain
    • dyspnoea
    • haemodynamic instability — shock, hypotension, syncopal episodes

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

  • child aged older than 2 years without oral iron supplementation for a minimum of 12 weeks (or where oral iron supplementation not tolerated) without suspicion of underlying illness or other cause for concern

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • refractory iron deficiency with any concerning features including:
    • unintentional weight loss greater than 5% within last 6 months
    • family history of gastrointestinal malignancy including colorectal cancer
    • asymptomatic haemoglobin 80 to 90g/L
    • unknown cause

Category 2 (appointment clinically indicated within 90 days)

  • recurrent iron deficiency with confirmation of diagnosis including autoimmune/inflammatory disorders, kidney failure or vascular malformation

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
  • family history including gastrointestinal/colorectal cancer, coeliac disease, inflammatory bowel disease (IBD)
  • dietary history
  • medications and allergies
  • oral supplementation trialled, including doses and duration
  • presenting symptoms including:
    • dates and frequency of symptoms
    • sensory and texture issues with food if any
    • food avoidance/restricted eating patterns if any
    • associated symptoms including dysphagia, eczema, asthma, prolonged illness/infection
    • previous management trialled/response
    • presence of concerning features

Additional information to assist triage categorisation

  • presenting symptoms including:
    • sensory and texture issues with food if any
    • food avoidance/restricted eating patterns if any
  • dietitian summary/report
  • 3-day food chart
  • weight/height trends
  • body mass index (BMI) if child is aged ≥ 16 years
  • growth chart trends
  • blood pressure trends
  • abdominal examination findings
  • pathology:
    • complete blood examination (CBE)
    • reticulocyte count — suspected iron deficiency anaemia
    • urea, electrolytes, creatinine (UEC)
    • liver function tests (LFTs)
    • random blood glucose level 
    • iron (Fe) studies
    • coeliac serology
    • thyroid function tests
    • folate level
    • vitamin b12 level
    • c-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • urinalysis
    • faecal calprotectin
    • faecal multiplex polymerase chain reaction (PCR)
    • stool microculture and sensitivities (M/C/S)
  • relevant diagnostic/imaging reports including location of company and accession number

Clinical management advice

Iron deficiency is primarily a nutritional disorder although it is also caused by physiologically increased requirements in children older than 5 years and in adolescents. Less common causes may be from iron absorption or chronic blood loss. If left untreated, iron deficiency anaemia can lead to delays in development and learning difficulties.

Symptoms in children may present as paleness, fatigue, weakness, or a lack of energy, subpar growth, breathlessness, or the presence of a heart murmur. Older children may display behaviours of hyperactivity, disrupted sleep patterns, and difficulty concentrating.

Risk factors that contribute to iron deficiency include:

  • Aboriginal and/or Torres Strait Islander or refugee background/s
  • delayed introduction of solids
  • heavy menstrual bleeding
  • high consumption of cows’ milk
  • low birth weight
  • low maternal iron during pregnancy
  • poor diet
  • premature birth
  • recurrent illness/infections

Consider iron infusion with General Practitioner in appropriately selected adolescents (for example if a patient is otherwise healthy, symptomatic, good idea of deficiency aetiology, failed trial of oral supplementation).

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.