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.

  • acute Achilles tendon rupture
  • acute dislocation
  • acute ligament injury laceration
  • acute nerve injury
  • compound ‘tooth knuckle’ injury
  • crush injuries
  • fracture requiring manipulation or operation
  • hemarthrosis or tense effusion
  • injury associated with vascular compromise
  • multi ligament ankle or knee injury
  • open, unstable or suspected fracture
  • ruptured/lacerated tendon
  • severed limb/appendage (finger or toe)
  • skin laceration with suspected underlying structural damage
  • suspected acute compartment syndrome
  • suspected acute bone or joint infection, do not commence antibiotics until reviewed by specialist medical officer, contact the on-call registrar to discuss clinical concerns

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to 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

  • undisplaced fracture
  • delayed presentation nerve or tendon injury
  • delayed presentation joint dislocation
  • trauma or fracture not requiring immediate attention

Category 2 — appointment clinically indicated within 90 days

  • non-union fracture
  • malunion affecting function
  • ankle injury with persistent pain > 6 weeks

Category 3 — appointment clinically indicated within 365 days

  • malunion with normal function
  • ankle sprains with or without pain unresponsive to maximal medical management ≥ 3 months

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 including relevant surgical history
  • current medication list
  • body mass index
  • functional range of motion (ROM)
  • private health cover/compensable status e.g. WorkCover claims
  • neurovascular assessment, emergency presentations and category 1
  • management history including:
    • injury/trauma, if relevant
    • onset and duration
    • pain
    • associated features, e.g. swelling and/or instability
    • functional impact
    • use of immobiliser/splint/cast
  • plain X-ray anterior posterior/lateral - consider adding weightbearing for chronic foot and ankle, include radiological details/accession number
  • ultrasound (US) if appropriate

Clinical management advice

Ensure referrals are completed early as treatment options change with delayed referral.

Consider fracture clinic first appointment’s timing including:

  • documented adequate alignment and satisfactory management ≤ 14 days of referral
  • all other fracture cases, delayed presentation of tendon and nerve injuries to be reviewed ≤ 7 days of referral.

Optimisation of chronic medical conditions should occur as part of initial assessment and conservative management as this may impact on suitability for surgical intervention.

Clinical 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.