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.

  • airway compromise-stridor/drooling breathing difficulty/acute or sudden voice change/severe odynophagia
  • acute hoarseness associated with neck trauma or surgery

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

  • presentations with red flag symptoms
  • recent change to voice and persistent hoarseness which fails to resolve in four weeks and must include a background history of any of the following:
    • history of current smoking, or excessive alcohol intake
    • recent intubation
    • recent cardiac or thyroid surgery
  • persistent hoarseness in a patient with a known gastric, lung or ear, nose and throat (ENT) malignancy

Category 2 — appointment clinically indicated within 90 days

  • recurrent episodes of hoarseness, altered voice in patient with no other risk factors for malignancy

Category 3 — appointment clinically indicated within 365 days

  • chronic hoarseness without risk factors or red flag symptoms

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.

  • history of presenting complaint including duration length and symptoms
  • neurological assessment/history
  • smoking/vaping status - if active, strongly consider referral for smoking/vaping cessation
  • occupation - may be related to dysphonia
  • presence of red flags including:
    • persistent hoarseness > 3 weeks
    • dysphagia
    • unilateral symptoms of throat pain or ear pain
    • neck lump
  • past history of head and neck cancer, especially in smokers

Additional information to assist triage categorisation

  • speech pathology report
  • medication history

Clinical management advice

  • consider the following:
    • diabetes, gastroesophageal reflux, hypothyroidism, oropharyngeal tumours, lung lesion, recurrent laryngeal nerve damage or chronic rhinosinusitis if indicated
    • speech pathology assessment if concern about voice quality
  • assess for the following red flag symptoms including:
    • persistent hoarseness > 4 weeks
    • dysphagia
    • unilateral symptoms of throat pain or ear pain
    • neck lump
  • identifying past history of head and neck cancer, especially in smokers

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.