Neurology Referrals

Find assessment and management information on Neurology conditions at:

Emergency: Immediate transfer to the Emergency Department

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the Emergency Department or seek emergent advice if in a remote area.

  • >50 years with raised CRP/ESR with suspected temporal arteritis
  • Acute neurological symptoms of a stroke; multiple/crescendo TIA
  • Acute onset or rapid progression (over hours or days) motor impairment with functional loss
  • Acute onset severe progressive ataxia, vertigo and/or visual loss
  • Acute rapidly progressive weakness (Guillain-Barre Syndrome, myasthenia gravis, myelopathy)
  • Acute severe exacerbation of known MS
  • Bilateral leg weakness with or without bladder and/or bowel dysfunction
  • Ear conditions with associated neurological signs i.e. facial palsy
  • First severe headache age >50 years
  • Headaches with papilledema or focal neurological signs
  • New acute stroke/TIA patients
  • Patients with acute neurological symptoms of a stroke within the past 7 days
  • Prolonged post-ictal period
  • Seizure without known history of seizure disorder
  • Seizures due to substance withdrawal
  • Severe headache associated with recent (1-2 days) head trauma or if on anticoagulants
  • Severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
  • Status epilepticus/epilepsy with concerning features:
    • Focal deficit post-ictally
    • Seizure associated with recent trauma
    • Persistent severe headache > 1 hour post-ically
    • Seizure with fever
  • Sudden onset delirium or confusion with or without fever
  • Sudden onset/thunderclap headache
  • Sudden movement disorder involving ocular movement

To arrange an urgent review or advice, please phone the Royal Perth Hospital (RPH) switchboard on 9224 2244 and ask to speak with the on-call registrar for the relevant speciality.

After verbal clinical handover and agreement with the registrar that the patient requires an appointment with RPH within 7 days please email the patient’s referral to:

RPH, Central Referral Receipting RPH.OutpatientReferrals@health.wa.gov.au

Ensure the referral is:

  • marked IMMEDIATE
  • the name of the registrar or consultant spoken with is written on the referral
  • all essential referral information, investigations, clinical photos are included

IMMEDIATE (Appointment within 7 days):

  • Abnormal neurological exam with concerning features, including malignancy or neuroimaging (new onset headache)
  • Idiopathic intracranial hypertension 
  • Rapidly progressing cognitive changes (over weeks)
  • Severe/acute trigeminal neuralgia with inability to eat
  • Severe symptoms or abrupt onset/deterioration of movement disorder

Neurology manages the following conditions.

Referrals are triaged based on clinical priority following these guidelines:

Specialist Clinics/Services include

  • General neurology, including rapid access clinics
  • Epilepsy, and first seizure clinics
  • Cognition and memory
  • Neurogenetics
  • Myelin
  • Neuroimmunology
  • Neuropathy
  • Stroke/TIA
  • Botulinum toxin
  • Neurology Technical services including EMG, EEG

Neurology referral guide is available at Central Referral Service guide for referrers (health.wa.gov.au) and is for the following conditions:

Please include all relevant investigations with your referral.

If a specific test result is unable to 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 referral.

 

Minimum standard referral is included in the standard referral template (external link) and available on the Department of Health website (external link).

Please ensure patient email and mobile phone numbers are included to facilitate patient contact.

Patients can be flagged for video or telephone consultations at referral, triage or follow-up.

Please Note: Neurology has an extensive outpatient waitlist for routine referrals. Consider alternate referral pathways such as:

Ensuring full condition clinical pathways have been explored via Neurology - Community HealthPathways Western Australia

Referral to Contracted Medical Practitioners within EMHS. See our full list of specialists here

Named referrals for Neurology will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principles from the outpatient waitlist.

The following are not routinely provided in a public Neurology service. Neurology referral criteria – Adult (health.wa.gov.au)

 
 

Condition

Details (where applicable)

Acquired brain injury

Specific exclusions:

  • Chronic sequelae of acquired brain injury, except for epilepsy.
  • Post-concussion syndrome or rehabilitation of acquired brain injury (consider referral to Rehabilitation Medicine / Community Rehabilitation / Day Therapy /State Head Injury Unitas appropriate).

Please refer to the following HealthPathways:

Certification of a patient’s ability to drive, for private standards, in the presence of a neurological condition

Unless specified as a requirement by the Department of Transport (seeAustroads Guidelines (external site)for assessing the fitness to drive).

Please refer to the following HealthPathways:

Chronic headache where standard treatment has not been tried

Consider trialling conservative/standard treatment.

Please refer to the following HealthPathway:

Chronic low back pain, neck pain or radicular pain; chronic pain or non-specific pain syndromes

Consider referral to pain services and/or allied health as appropriate.

Please refer to the following HealthPathway:

Chronic neurological conditions that are well controlled and do not require additional intervention

For example: chronic epileptic patient on stable drug therapy and no seizures for 10 years, do not need to be referred for ‘routine’ review.

Cognitive impairment > 65-year-old

Consider referral to geriatric medicine and aged care services as appropriate. Patients whose primary and major diagnosis/symptomatology are alcohol, drug or psychiatry related (consider referral to drug and alcohol service or mental health service as first line).

Please refer to the following HealthPathway:

Lyme disease or Lyme-like illness

Please refer to:

Fibromyalgia/Chronic Fatigue Syndrome

Consider referral to rheumatology/pain services/general medicine, as appropriate.

Please refer to the following HealthPathways:

Neurological symptoms due to treatment non-adherence
  • e.g. seizures

Parkinson’s disease > 65 years old unless referred by specialist

Consider referral to geriatric medicine/community rehabilitation/day therapy Unit as appropriate.

Please refer to the following HealthPathways:

Distal symmetrical painful sensoryneuropathyassociated with diabetes or alcoholism

Patients with long history of distal symmetrical painful sensory neuropathy associated with diabetes or alcoholism referred for pain management (consider referral to Chronic Pain service).

Please refer to the following HealthPathway:

Restless leg syndrome

Please refer patients to Sleep Medicine

Small‑fibreneuropathypreviously diagnosed by a neurologist

If referred for symptom management, consider referral to Pain service.

Please refer to the following HealthPathway:

Seizures known to relate to drug/alcohol use

Consider referral to drug and alcohol services as appropriate.

Please refer to the following HealthPathway:

Sleep disorders

Consider referral to sleep medicine as appropriate.

Please refer to the following HealthPathway:

Syncope

Consider medical or cardiology referral as appropriate.

Please refer to the following HealthPathways:

Tremor of long duration or milder severity

Please refer to the following HealthPathway:

Uncomplicated Bell’s palsy

Routine follow-up

Please refer to the following HealthPathway:

Vertigo with hearing loss

Consider ENT referral as appropriate.

Please refer to the following HealthPathway:

Workers compensation and medico-legal cases

Please refer to:

While the WA Health Excluded Procedures precludes procedures performed for cosmetic or other non-medical reasons, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals.

To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at Royal Perth Hospital, referral criteria have been established.

Visit the referral criteria for each of the six WA Health excluded procedures page for more information.

The following are not routinely provided in a public service:

EMHS is responsible for providing public health services to the people who reside within its boundaries.

The catchment map (PDF 400KB) outlines the suburb catchment areas for East Metropolitan Health Service (EMHS). The country areas that flow to EMHS are Kimberley, Pilbara and Wheatbelt.

Referral to a hospital for assessment and/or treatment is based around multiple criteria. These include:

  • Place of residence – most hospitals have catchments to help service people closer to home. For country patients, the residence of family with whom they will reside whilst attending appointments can be taken into consideration.
  • Age – RPH is an Adult Hospital, children are only treated by some hospitals.
  • Hospital location of specialty services – some conditions need designated specialist services that are not available at all hospitals.

Please use this information to guide referrals to the hospital servicing your patient's residence, and inform your patients of these criteria when you are referring them for public hospital services via the Central Referral Service (CRS).

Last Updated: 18/04/2023