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.

  • concerning features of obstructive airway:
    • acute hoarseness
    • acute or sudden voice change
    • difficulty breathing
    • drooling
    • severe odynophagia
    • stridor

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

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • presentations with one or more concerning features:
    • dysphagia
    • neck lump
    • persistent hoarseness greater than 3 weeks
    • unilateral symptoms of throat pain or ear pain
  • stridor/choking when feeding
  • unresolved voice and persistent hoarseness for a minimum of 3 weeks with a history of:
    • recent intubation, and/or
    • recent cardiac, and/or
    • recent thyroid surgery

Category 2 (appointment clinically indicated within 90 days)

  • persistent moderate to severe hoarseness and voice loss greater than 4 weeks
  • suspicion of any of the following:
    • papilloma
    • thrush
    • vocal cord palsy

Category 3 (appointment clinically indicated within 365 days)

  • chronic hoarseness without concerning features

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
  • onset, duration, and progression of symptoms, including:
    • define patient's meaning of 'hoarseness'
    • history of overuse of voice (shouting/yelling)
    • history of vocal cord cysts or nodules
    • history of gastro-oesophageal reflux
    • weak cry, choking during feeding,
    • cyanotic or blue spells
  • management history including treatments trialled/implemented prior to referral including allied health summaries
  • naso-oropharyngeal examination
  • physical examination:
    • exclude viral or bacterial infection
    • signs of airway obstruction e.g. listen to the patient's voice, and assess cough and swallowing
    • concerning features
    • neurological assessment
  • neck examination:
    • scars
    • lymph nodes
    • thyroid gland
    • localised tenderness/pain radiating to ear
  • relevant diagnostic/imaging reports including location of company and accession number

Additional information to assist triage categorisation

  • speech pathology report/summary

Clinical management advice

Initial approaches for managing dysphonia include:

  • addressing potential bacterial infections, such as sinusitis with noticeable postnasal drip
  • be attentive to potential viral infections and provide supportive care as needed
  • advise voice rest to facilitate recovery
  • if voice quality is a concern, consider a speech pathology evaluation

Assess for the presence of:

  • gastroesophageal reflux
  • hypothyroidism
  • oropharyngeal issues that might lead to a muffled voice
  • possible recurrent laryngeal nerve damage
  • chronic rhinosinusitis if appropriate

Please utilise the relevant Aboriginal Liaison Units (ALU) to provide support to Aboriginal families.

Clinical resource

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.