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.

  • loss of consciousness in association with palpitations
  • sudden loss of consciousness during exercise
  • possible infantile spasms in a baby < 12 months, which may include frequent brief episodes of head bobbing with or without arm extension

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

  • recurrent vasovagal syncope of unknown aetiology
  • refractory postural hypotension
  • breath-holding spells
  • functional neurological disorder
  • seizure/epilepsy
  • headache/migraines
  • anaemia
  • medication toxicity — for example clonidine

Exclusions

  • narcolepsy, refer to narcolepsy - respiratory and sleep medicine
  • refer to cardiology for the following suspected origin:
    • brady/tachyarrhythmia
    • long QT syndrome
    • Brugada syndrome
    • Wolff-Parkinson-White syndrome
    • postural orthostatic tachycardia syndrome
    • structural abnormalities — aortic stenosis, hypertrophic cardiomyopathy

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • syncopal/pre-syncopal episodes with any concerning features including:
    • chest pain or palpitations
    • cyanosis or pallor
    • falls
    • funny turns symptomatic of atypical seizures
    • injury
    • unexplained loss of consciousness

Category 2 (appointment clinically indicated within 90 days)

  • child with any of the following:
    • probable breath-holding spells
    • episodic vaso-vagal
    • sleep disturbance related
    • self-stimulatory/behavioural

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 – please provide any relevant features as relating triage categories
  • family history of genetic cardiac arrhythmia/s, or sudden unexplained death in children or young adult/s
  • medications and allergies
  • presenting symptoms and features including:
    • chest pain or palpitations
    • cyanosis or pallor
    • falls
    • funny turns symptomatic of atypical seizures
    • injury
    • unexplained loss of consciousness
    • duration and onset of symptoms
    • frequency of events, episodes, witnessed/unwitnessed
  • height and weight
  • body mass index (BMI) if child is aged ≥ 16 years
  • physical examination findings

Additional information to assist triage categorisation

  • smoking, alcohol and other drug status
  • growth chart trends
  • blood pressure (trends, postural blood pressure)
  • urinalysis
  • echocardiogram (ECHO)
  • electroencephalogram (EEG) – please note EEG is not usually recommended for syncope and are therefore only suggested if seizures are strongly suspected
  • bloods:
    • haemoglobin 
    • ferritin
    • electrolytes
  • 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.