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.
- abscess/hematoma in the neck
- peritonsillar, parapharyngeal, salivary, retropharyngeal
- acute vocal hoarseness/sudden voice change
- acutely enlarging neck mass
- airway compromise/stridor/obstruction
- cellulitis
- difficulty breathing
- foreign body for example, fish/chicken bone, or button batteries **urgent review**
- obstructive food bolus
- severe odynophagia/drooling
- trauma
- uncontrolled pain
- systemic infection
Please contact the on-call registrar to discuss your concerns prior to referral.
For clinical advice, please telephone the relevant specialty service.
If clinical advice is required urgently or out of hours, please contact Flinders Medical Centre or the Women’s and Children’s Hospital.
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 (appointment clinically indicated within 30 days)
- stridor with feeding or swallowing difficulties and/or associated signs of any respiratory distress
- evidence of biphasic stridor
- suspected aspiration pneumonia
- dysphagia with:
- hoarseness/weak cry and/or
- progressive weight loss or poor weight gain
Category 2 (appointment clinically indicated within 90 days)
- intermittent dysphagia
- stridor without concerning features outlined in category 1
- significant stenotic/dysphagic symptoms and any of the following:
- difficulty swallowing/pain/pressure in chest/heartburn
- gagging/choking and/or coughing when swallowing
- post prandial shortness of breath without known cause
- regurgitation of food or liquids to throat, mouth, and/or nose after swallowing
- sensation of food/fluids stuck in throat or chest
- weight loss/loss of appetite/food avoidance
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.
- age
- past medical/surgical/neurological history including cerebral palsy, degenerative neurological disorder
- current medications
- allergies and sensitivities
- onset, duration, and progression of symptoms
- gagging on solid food
- progressive weight loss or poor weight gain
- naso-oropharyngeal examination including:
- airway obstruction
- craniofacial features
- neurological assessment
- relevant diagnostic/imaging reports including location of company and accession number
Additional information to assist triage categorisation
- speech pathology report
- dietetics report
- chest X-ray
- barium swallow including location and accession number
- videofluoroscopic swallowing study (VFSS)
Clinical management advice
The following referral pathways should be considered when assessing people with sub-acute dysphagia:
- neuromuscular - consider referral to paediatric medicine
- oesophageal stricture/motility disorder/suspected malignancy - consider referral to paediatric gastroenterology
- oropharyngeal - refer to ear, nose and throat (ENT)
- resolving soft food bolus - consider referral to paediatric gastroenterology
Consider referral for a speech pathology swallow assessment at time of referral. A videofluoroscopy swallowing study (VFSS) is recommended when there is concern about how well a child or infant swallows, how well the airway is protected during swallowing, and/or how well food moves from the mouth through the oesophagus. A videofluoroscopy may be considered if some of the following symptoms occur regularly and haven’t improved after intervention with a speech pathologist:
- frequent choking
- coughing or gagging during meals/drinking
- trouble managing saliva
- gurgly/wet breathing during or after meals
- chronic respiratory problems including chest infections/pneumonia
- difficulty swallowing
VFSS referrals are accepted at Flinders Medical Centre and the Women’s and Children’s Hospital speech pathology services. All feeding/swallowing difficulties without concerning features should be considered for referral to speech pathology at your nearest provider.
Please utilise the relevant Aboriginal Liaison Units (ALU) to provide support to Aboriginal families.
Clinical resources
- Royal Children’s Hospital Melbourne – Acute upper airway obstruction
- Royal Children’s Hospital Melbourne - Foreign bodies inhaled
- SA Health - South Australian Paediatric Clinical Practice Guidelines Croup (PDF 813KB)
- SA Health - South Australian Paediatric Clinical Practice Guidelines Ingested foreign bodies (including button batteries) (PDF 254KB)
- Speech Pathology Australia - Swallowing difficulty
- Therapeutic Guidelines - Croup
- Therapeutic Guidelines - Dysphagia in a person with developmental disability
- Women's and Children's Hospital Aboriginal Liaison Unit / Taikurrinthi
- Flinders Medical Centre Aboriginal Hospital Liaison Unit / Karpa Ngarrattendi
- Alternative ear health services and resources for Aboriginal children in South Australia
Consumer resources
- Health Direct – Croup
- Health Direct - Dysphagia
- Royal Children's Hospital Melbourne - Croup fact sheet
- Speech Pathology Australia
-
Alternative ear health services and resources for Aboriginal children in South Australia
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.