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.

  • if the stridor is acute, please refer to the emergency department if there are signs of respiratory distress, fevers or “stridor at rest”
  • if the wheezing is acute, consider acute bronchiolitis and foreign body aspiration and refer to emergency department if there is signs of respiratory distress or history of inhalation

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

For clinical advice, please telephone the relevant specialty service.

Southern Adelaide Local Health Network

Women's and Children's Health Network

Inclusions

  • stridor not requiring referral to emergency department (see Referral to Emergency)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • stridor in infants < 3 months of age
  • evidence of biphasic stridor (stridor occurring with both inspiratory and expiratory phases of breathing)
  • stridor with poor growth
  • referrals from paediatric Ear, Nose and Throat post flexible nasoendocopsy confirming upper airway pathology

Category 2 (appointment clinically indicated within 90 days)

  • mild stridor without feeding difficulties

Category 3 (appointment clinically indicated within 365 days)

  • nil

Additional information to assist triage categorisation

  • relevant allied health/diagnostic/imaging reports, including location of company and accession number
  • feeding quality

Clinical management advice

  • both paediatric Respiratory Medicine and paediatric Ear, Nose and Throat departments typically see all children with stridor as a category 1, and work in parallel to manage these patients
  • if the stridor is mild, present from birth and the child is thriving, referrals can be directed to paediatric Ear, Nose and Throat and/or Paediatric Respiratory Medicine for evaluation
  • if there are any signs of respiratory distress and the child is not thriving, please refer to Paediatric Respiratory Medicine for further evaluation

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.