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Incontinence

PAEDIATRIC

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.


Paediatric surgery registrars at Queensland Children's Hospital/ GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

    • Queensland Children's Hospital: 07 3068 1111

    • GCUH: 1300 744 284

Burns

All major burns require emergency management and referral

The Paediatric Burns Centre (PBC), Qld Children’s Hospital offers a 24/7 referral service. For a referral coming from regional QLD, an email referral service is available. Criteria for referring to our service is based on the Australian New Zealand Burns Association transfer guidelines for Burns Service referral.

  • For those burns located in the Mackay region and above, please refer to Townsville Hospital first (07) 4433 1111
  • For those burns located in the Gold Coast region and below to Grafton NSW, please refer to Gold Coast University Hospital first. Paediatric surgical registrar or on call surgical cover 1300 744 284

If these hospitals are unable to care for the patient, then please follow the information below to refer to PBC

To refer a patient to the Paediatric Burns Centre (Qld Children’s Hospital);

  • Contact the Burns Register on call via switch (07) 3068 1111
  • Complete Category 1 Referral to Burns Outpatients (QH staff only)
  • Submit referral form by clicking ‘submit at the end of the form or by emailing through to burns-opd@health.qld.gov.au
  • Attach any photos to this email if possible
  • If advised that the patient can be treated locally, continue to contact the burns Registrar at each dressing change to update progress and send through photos to above email address

All paediatric patients should be referred to the PBC however they may not physically be required to attend the Queensland Children’s hospital. If treatment can be managed in the local area, then this is the preferred treatment

Antenatal & neonatal surgical conditions

  • Patients with congenital malformations causing bowel obstruction or respiratory compromise are emergency referrals not outpatients. Resuscitation and safe transfer to tertiary paediatric unit is a priority. Notify neonatal unit or appropriate neonatal/paediatric medical specialist of neonatal/fetal diagnosis as per local protocol.
  • Acute neonatal bowel obstruction

Enlarged lymph nodes/midline neck swelling

  • Acute infective node with no improvement within 48 hours
  • Nodes rapidly increasing in size, overlying skin erythema or very tender
  • Acute infection not responding to treatment/antibiotics present to emergency

Umbilical and peri umbilical pathology

  • Any painful, red, or irreducible hernia – discuss with on-call paediatric surgical registrar
  • Suspected vitello-intestinal remnant or patent urachus

 Abdominal pain - chronic

  • Acute abdominal pain (suspected serious pathology) especially severe pain or peritonitis
  • Intussusception
  • Hypertrophic pyloric stenosis
  • Suspected bowel obstruction with bile stained vomiting
  • Suspected malignancy – discuss with on-call paediatric surgical registrar if serious pathology is suspected

Perineal conditions

  • Severe pain or peritonitis

 Perianal conditions

  • Acute abscess

Constipation and encopresis

  • Acute neonatal bowel obstruction

Vomiting

  • Bile stained vomiting is a surgical emergency – phone the on-call paediatric surgical registrar,
  • Suspected pyloric stenosis – phone the on-call paediatric surgical registrar

Stomas and abdominal devices

  • Accidental removal of gastrostomy button or ACE tubing – phone on-call paediatric surgical registrar
  • Any stomal or abdominal device issues refer to treating hospital

Hernia, hydrocele and testicular conditions

  • Irreducible, incarcerated or strangulated inguinal hernia
  • Suspected testicular torsion
  • Inguinal hernia: If under <52 weeks post conceptual age, call nearest paediatric surgical unit for urgent review
  • Acute scrotal pain with or without swelling
  • Ambiguous genitalia and neonatal bilateral undescended testes are urgent referrals to service

Renal and bladder congenital lesions

  • Acute retention
  • Poor urinary stream in neonate / suspected valves

Urinary tract infections (UTI)

  • Acute infant urinary tract infection presenting septicaemia or acutely unwell
  • Hypertension > 97 percentile for age and/or height
  • Presumed UTI in infant <3 months

Penile conditions

  • Paraphimosis (when unable to replace foreskin)
  • Disorder of sexual development (DSD) – refer to paediatric surgeon or paediatric medicine immediately

Skin and soft tissue masses

  • Acute breast infection requiring admission or drainage
  • Acute infection - if unresponsive to treatment or acutely unwell from infection
  • Suspected solid paediatric tumours should be urgently referred through local paediatric medical service and/or paediatric oncology services

Vascular anomalies/haemangioma

  • Obstruction of vision, airway compromise, uncontrolled bleeding, ulceration, suspected  kapsiform haemangioendothelioma (KHE) or cardiac output compromise  - contact paediatric surgical registrar on call

  • Refer to local Healthpathways or local guidelines
  • Sudden onset incontinence who have previously been dry can be a marker of serious pathologies (e.g. DM, GU tumours, spinal cord problems) and should be assessed urgently by general paediatrics
  • Refer to general paediatrics if there are no structural abnormalities
  • Refer to paediatric urology or paediatric surgery if concerned with renal or structural abnormalities
  • Paediatric surgery registrars at Queensland Children's Hospital/ GCUH can offer telephone advice to rural HHS. In some areas it would be more appropriate to seek initial advice from local paediatric medical service or general surgery services:

    • Queensland Children's Hospital: 07 3068 1111
    • GCUH: 1300 744 284

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)

    • New onset incontinence in a previously dry child

  • Category 2
    (appointment within 90 calendar days)
    • Primary daytime incontinence

      Refer to general paediatrics if there are no structural abnormalities
      Refer to paediatric urology or paediatric surgery if concerned with renal or structural abnormalities
  • Category 3
    (appointment within 365 calendar days)
    • Nocturnal enuresis

      Refer to general paediatrics if there are no structural abnormalities
      Refer to paediatric urology or paediatric surgery if concerned with renal or structural abnormalities

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Details of neurological exam for patients with secondary incontinence
  • Result of urine dipstick for exclusion of UTIs and glycosuria

3. Additional referral information Useful for processing the referral

  • Any radiological investigation results
  • Any frequency voiding diary results
  • Description of the pattern of wetting
  • Family history of wetting

4. Request

Patient's 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

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

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.)
  • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • 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.