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.

  • acute urinary retention
  • incontinence with abnormal neurological examination findings
  • urosepsis
  • suspected cauda equina syndrome

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

  • incontinence related to developmental delay/neurodiverse diagnosis

Exclusions

  • primary nocturnal enuresis
  • day wetting without allied health involvement prior to referral

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • incontinence associated with concerning features including:
    • neurological examination abnormalities. Contact the paediatric medicine on-call registrar to discuss your concerns prior to referral

Category 2 (appointment clinically indicated within 90 days)

  • incontinence in child with any of the following:
    • associated with a history of recurrent urinary tract infections (UTIs)
    • infrequent voiding — fewer than 3 times per day
    • investigated by child protection services
    • loss of continence after 6 months of dryness
    • mental health concerns
    • secondary enuresis or new onset incontinence in a previously dry child
    • suspected congenital or structural abnormalities
    • suspected or confirmed developmental delay/neurodiverse
    • under the custody or guardianship of the Chief Executive
    • unusual social circumstances

Category 3 (appointment clinically indicated within 365 days)

  • incontinence in child with any of the following:
    • secondary enuresis or new onset incontinence in a previously dry child
    • day wetting in child greater than 4 years of age
    • nocturnal enuresis child greater than 7 years of age

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
  • presenting symptoms history, including:
    • daytime accidents
    • frequency
    • urgency
    • straining
    • pain on urination
    • if periods of dryness ask about physical, emotional and social triggers
    • previous treatments
    • history of constipation
    • history of urinary tract infections
  • height and weight
  • body mass index (BMI) if child is aged 16 years or older
  • examination findings
    • abdominal examination
    • neurological examination — secondary enuresis/regression
    • urinalysis (dipstick) result - if glucose present, ensure BGL also performed
  • pathology — mid-stream urine (MSU) microscopy, culture and sensitivity

Additional information to assist triage categorisation

  • growth charts
  • blood pressure
  • bladder diary
  • kidneys, ureters, bladder ultrasound including pre and post volumes
  • relevant diagnostic, imaging reports including location of company and accession number

Clinical management advice

Please note that urinary incontinence/enuresis referrals can be managed by the following specialist services:

Sudden onset incontinence in children who have previously been dry (for at least six months) can be a marker of serious pathologies such as diabetes mellitus, genitourinary tumours and spinal cord problems, and should be assessed urgently.

Alternative causes that could play a role in nocturnal enuresis, such as diabetes, urinary tract infection (UTI), fecal soiling, pinworm infestation, renal failure, seizures, sleep disorders, and other related conditions.

Children diagnosed with developmental delay, autism spectrum disorder (ASD), and/or attention deficit disorder (ADD) with urinary incontinence need an occupational therapist (OT) assessment and plan of urinary continence prior to referral.

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.