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.

  • concerns pertinent to any medical/surgical condition which raise the possibility of serious underlying disease (malignancy or infection) should be reviewed by the appropriate specialty either via emergency department or high priority outpatient appointment.

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • pain that has lasted less than three months

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • chronic cancer pain – from the cancer or cancer treatment
  • child under the Guardianship of the Chief Executive
  • patients on a palliative care pathway where the patient’s specialist team is requesting Chronic Pain Service input
  • newly diagnosed or suspected complex regional pain syndrome (CRPS)

Category 2 (appointment clinically indicated within 90 days)

  • chronic primary pain – where pain exists in one or more anatomical regions and is associated with significant emotional distress or disability
  • chronic post-surgical pain
  • chronic neuropathic pain – pain caused by a lesion or disease of the somatosensory nervous system
  • chronic headache and orofacial pain – whereby pain occurs at least 50% of days during the last three months and neurological review has already occurred
  • chronic visceral pain – pain that originates from the internal organs of the head and neck regions and the thoracics, abdominal and pelvic cavities
  • chronic musculoskeletal pain – pain that arises as part of a disease process affecting the bones, joints, muscles, or related soft tissue

Category 3 (appointment clinically indicated within 365 days)

  • nil

Considerations prior to referral

Prior to referral to a public specialist outpatient service please consider whether:

  • the child has a general paediatrician given the important role the paediatrician plays in overseeing and coordinating care for a child with chronic pain
  • all reasonable medical investigations have been completed
  • reasonable management in the primary care or hospital sector has been tried with insufficient success
  • chronic pain is having significant impact on life and therefore warrants referral to the multidisciplinary specialist chronic pain service
    • sleep, self-care, pain necessitating the assistance of others, pain impacting mobility, school attendance, socialisation, recreation, relationships and/or emotional regulation
  • chronic pain exacerbations have resulted in extreme distress or repeated hospital presentations/admissions and therefore warrants referral to the multidisciplinary specialist chronic pain service
  • current medication management is not providing relief nor leading to improved quality of life - escalating opioids requirements, and therefore warrants referral to the multidisciplinary specialist chronic pain service

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.

  • relevant medical diagnoses
  • relevant surgical diagnoses
  • relevant imaging - please attach relevant reports
  • relevant psychiatric or psychological history including name of treating practitioner and past and present treatments
  • relevant physical examination findings
  • describe any developmental, learning or communication difficulties and current level of support required
  • describe any physical disabilities and current level of support required - use of aids, full assistance required
  • functional status including details about school attendance and participation, participation in activities of daily living, sleep hygiene and physical activity - incidental and organised
  • relevant details of current or previous treatments from other specialists for the same problem - include name and service provider details
  • relevant details of current or previous treatments from allied health service providers for the same problem - include name and service provider details including National Disability Insurance Scheme (NDIS) providers if relevant
  • list past and present pain medications - approximate dates commenced/ceased and side-effects/allergies/ adverse effects
  • living circumstances including details about complex family demographics and any custody arrangements where relevant - Department of Child Protection involvement

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.