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.

  • nil

For clinical advice, please telephone the relevant specialty service.

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)

  • newborn with unstable hip – generally seen within 2 weeks for rapid access assessment due to urgency of clinical condition
  • abnormal clinical examination
    • positive Ortolani’s or Barlow’s test
    • limited hip abduction
    • leg length discrepancy
  • dislocated or subluxated hip on imaging, regardless of age
  • severe acetabular dysplasia on ultrasound or x-ray, regardless of age
  • persistent hip dysplasia at 3 months old or older on ultrasound (femoral head coverage of <50% and/or alpha angle <60 degrees) or on x-ray

Note: Patients with breech presentation or family history of developmental dysplasia of the hip (DDH) should trigger need for ultrasound at 6 weeks of age, and if abnormal clinical findings refer to Orthopaedic Surgery.

Category 2 (appointment clinically indicated within 90 days)

  • mild dysplasia noted on x-ray with normal clinical examination

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
  • risk factors including:
    • female
    • breech delivery
    • intrauterine packaging deformities e.g. plagiocephaly, foot deformities or torticollis
    • family history of developmental hip dysplasia (DDH)
    • pregnancy history
    • first-born status
    • other syndromic problems, e.g. club foot/feet
  • physical examination including:
    • limited hip abduction
    • leg length discrepancy
    • abnormal gait after walking age

Note: examine hip using Barlow’s or Ortolani’s test for hip instability at every well-baby check

  • investigations including:
    • hip ultrasound if aged under 6 months. To be done at age adjusted 4-6 weeks, not earlier, unless suspecting irreducible dislocated hip
  • x-ray anterior posterior (AP) pelvis and frog leg views if aged 6 months or over. Note: include imaging reports and date, provider and location of imaging
  • relevant family history of DDH

Clinical management advice

  • Patients with breech presentation or family history of DDH should trigger need for ultrasound at 6 weeks of age, and if abnormal clinical findings refer to Orthopaedic Surgery.
  • Asymmetrical thigh, groin and buttock creases are very common in the general population of infants and are not a reason for referral in the absence of other signs.

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.