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.

  • infants with the following symptoms:
    • significant breathlessness
    • feeding concerns with failure to thrive
    • abnormal cardiac signs, e.g. reduced pulses, organic murmur, hepatomegaly signs
  • non-infants with new onset of symptoms or signs of cardiac failure

If uncertain about urgency, please discuss with cardiologist on-call - see ‘Contacts for clinical advice’.


Important: In the event of an emergency, or if there is concern regarding the patient’s condition deteriorating and safe transport, call 000 and arrange transfer via SA Ambulance Service.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Inclusions

  • patients with clinical suspicion of heart failure which may include:
    • breathlessness
    • increased work of breathing
    • orthopnoea
    • exercise intolerance
    • poor weight gain or excessive weight gain
    • hepatomegaly
    • sacral oedema (infant) or pitting lower limb oedema (older child)

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • patients with new onset symptoms suggestive of heart failure but not requiring presentation to Emergency Department

Phone Cardiology to clarify if unsure whether presentation to Emergency is required, see ‘Contacts for clinical advice’

Category 2 (appointment clinically indicated within 90 days)

  • nil

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.

  • clinical history including symptoms, duration, exercise tolerance
  • clinical findings suggestive of cardiac failure, see ‘Inclusions’
  • other cardiac examination findings – blood pressure (BP), respiratory rate (RR), precordial findings, murmurs, pulses
  • growth centiles, growth trajectory
  • family history of cardiac conditions

Additional information to assist triage categorisation

  • oxygen saturations
  • electrocardiogram (ECG)
  • chest x-ray (CXR)

Clinical management advice

Heart failure should be formally diagnosed after comprehensive evaluation and management by a paediatric cardiologist.

Consumer resources

For information on Congenital Heart Defects (CHD) refer to resources in Congenital Heart Defects CPC.

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 role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) 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 referring clinician once the transfer of care has occurred.