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.

  • any acute onset or subacute rapidly progressive neurological symptoms, including:
    • ataxia or gait disorder
    • vertigo
    • muscle weakness including limbs, bulbar or neck muscles
    • visual loss or diplopia
  • suspected or confirmed cerebral vasculitis
  • suspected or confirmed autoimmune encephalitis

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

Any of the below conditions which are new onset but not requiring hospital admission:

  • suspected or confirmed MS including remitting, secondary progressive and progressive forms
  • suspected or confirmed neuromyelitis optica spectrum disorders (NMOSD)
    optic neuritis with suspicion for MS
  • suspected or confirmed myasthenia gravis or Lambert-Eaton myasthenic syndrome (LEMS)
    suspected or confirmed neurosarcoidosis

Category 2 — appointment clinically indicated within 90 days

Any of the below conditions already assessed and clinically stable requiring ongoing follow up:

  • suspected or confirmed MS including remitting, secondary progressive and progressive forms
    suspected or confirmed NMOSD
  • optic neuritis with suspicion for MS
  • suspected or confirmed myasthenia gravis or LEMS
  • suspected or confirmed neuro sarcoidosis

Category 3 — appointment clinically indicated within 365 days

  • chronic or slowly deteriorating (years) neurodegenerative illness
  • chronic longstanding (years) stable neuroimmune disorder for ongoing care, refer to ‘clinical management advice and resources’ as some of these patients benefit from referral to Allied Health services

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.

  • complete past medical history
  • current medication list including non-prescription medication, herbs and supplements
  • alcohol and other drugs, especially stimulants history
  • clinical history including:
    • symptoms including onset, duration, severity
    • degree of disability
  • screening neurological examination
  • relevant specialist medical reports and discharge summaries, if available
  • nerve conduction studies for neuromuscular presentations, if available

Additional information to assist triage categorisation

  • complete blood examination (CBE)
  • electrolytes, urea, creatinine (EUC)
  • liver function tests (LFTs)
  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • creatinine kinase
  • thyroid function tests (TFTs)
  • in suspected MS, magnetic resonance imaging (MRI) brain +/- spinal cord results, include radiology provider, accession number. If MRI is not able to be accessed, please specify this in the referral and, if appropriate, it may be arranged by the triaging clinician prior to the patient’s appointment

Clinical management advice

Not all referrals require consultation with a neurologist and patients may be reviewed in advanced practice nurse led clinics where medically appropriate. Nurse led clinics are part of best evidence-based practice and have been shown to reduce patient wait times, increase consultation duration, increase patient engagement and satisfaction, improve communication and provide access to tailored advice on self-management of disease and illness.

If the patient you are referring requires urgent attention and/or fulfils category 1 triage criteria, it is strongly recommended that you contact the outpatient department to ensure your referral has been received.

Patients with known MS

Suspected relapse (new/re-emergent neurological symptoms present > 24 hrs) should be assessed for provoking factors such as intercurrent infection, metabolic disturbance, environmental heat exposure etc. If identified these should be treated before referral - contact neurology registrar in patient’s Local Health Network, or the patient’s private neurologist, to discuss clinical concerns and obtain advice.

Allied health

Consider additional input depending on specific circumstances:

  • physiotherapy for gait, balance and falls
  • speech pathology for swallowing and/or communication difficulties
  • occupational therapy for upper limb and daily function difficulties
  • continence nursing for patients with bowel and bladder symptoms
  • rehabilitation physician for patients with prominent spasticity
  • chronic pain management unit
  • clinical psychology supports.

There are private and public options for accessing allied health services. For additional support in locating a suitable service in regional, rural and remote South Australia, contact the Country Referral Unit.

Driving

Consider whether your patient’s condition affects their fitness to drive as per Austroads Guidelines.

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.