Swallowing/Dysphagia

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Useful Management Information

Consider whether the patient has a package of care and if they have a level 3 or 4 package of care, please refer to a private speech pathology team/service.
All videofluoroscopic swallow study (VFSS) referrals must include a medical imaging request form.

Minimum Referral Criteria

Category 1	Suspected or confirmed oropharyngeal dysphagia that has the potential to require more complex or emergent care if assessment is delayed or is preventing eating and drinking. Indicators for this category: History of recurrent chest infections. Co-occurring dysphonia. Gagging, choking, and/or coughing when swallowing food/fluids. Food or liquids coming back up to throat, mouth, and/or nose after swallowing. Patient feels like foods or liquids have been getting stuck in their throat and are very concerned/anxious about swallowing problem. Weight loss/loss of appetite/food avoidance. Co-occurring Chronic Obstructive Pulmonary Disease, Multiple Sclerosis, Parkinson’s Disease, stroke, Anterior Cervical Discectomy and Fusion.
Category 2	Suspected or confirmed oropharyngeal dysphagia and condition is likely to require more complex care if assessment is delayed. Indicators for this category: Patient feels like foods or liquids have been getting stuck in their throat and are not concerned. Stable oropharyngeal dysphagia and/or to review progress/management plan.
Category 3	No category 3 criteria
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Clear reason for referral
History / Duration of symptoms/condition
Medical and social history with list of medication
Results of relevant medical assessments/investigations/management of condition/medical imaging

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Next of kin details
Patient awareness of referral
Any other health care professionals currently involved (e.g. other Allied Health Professionals, Health Clinicians)
Previous speech pathology or specialist assessment reports

Send Referrals To

Smart Referrals

Not available

Internal Referrals

Not available

Fax

Not available

Post

Not Available

Enquiries

Not available

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Swallowing/Dysphagia

Useful Management Information

Minimum Referral Criteria

If your patient doesn't meet the minimum referral criteria

Essential Referral Information

Additional Referral Information

Send Referrals To

Smart Referrals

Internal Referrals

Fax

Post

Enquiries

Service Availability

Facilities