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 metropolitan Local Health Network switchboard and ask to speak to 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

Southern Adelaide Local Health Network

Women's and Children's Health Network

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

For information on referral forms and how to import them, please view general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral 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
  • interpreter required
  • 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

Consumer resources