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.

  • profound dysphagia, e.g. inability to manage secretions
  • stridor
  • laryngeal obstruction and/or fracture
  • pharyngeal/laryngeal foreign body

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • suspicion of oropharyngeal lesion - dysphagia and any of the following:
    • hoarseness
    • unilateral otalgia
    • progressive weight loss
    • smoking history, excessive alcohol intake
  • recurrent chest infections (aspiration pneumonia)

Category 2 — appointment clinically indicated within 90 days

  • intermittent dysphagia
  • significant stenotic/dysphagic symptoms and any of the following:
    • gagging, choking, and/or coughing when swallowing
    • food or liquids coming back up to throat, mouth, and/or nose after swallowing
    • feel like foods or liquids are stuck in throat or chest or problems with eating or pain or pressure in chest or heartburn
  • weight loss/loss of appetite/food avoidance
  • shortness of breath post eating in absence of other cause

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.

  • presenting complaint history and symptoms
  • neurological assessment/history, e.g. stroke, progressive neurological disease
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • high resolution computerised tomography (CT) neck and chest with contrast, including company and accession number

Additional information to assist triage categorisation

  • thyroid stimulating hormone (TSH)
  • speech pathology report
  • dietetics report
  • chest X-ray
  • barium swallow/modified barium swallow report, include location and accession number

Clinical management advice

Please note that referrals can be managed by the following specialist services:

If acute obstruction caused by a:

  • foreign body at a pharyngeal level (e.g. chicken or fish bone), request acute ear, nose and throat (ENT) assessment
  • soft food bolus that has not cleared, request prompt acute upper gastrointestinal (GI) assessment
  • soft food bolus that has cleared, request gastroenterology assessment

If dysphagia and the most likely cause is:

  • oral or pharyngeal, request ENT assessment
  • oesophageal (e.g., stricture, motility disorder, or malignancy), request upper GI assessment
  • neuromuscular concern, consider neurology or geriatric assessment

If sinister causes excluded, consider adult speech pathology assessment.

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.