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Emergency Information 
Pediatric and Adolescent Gynecology Clinic Central Access and Triage   at
Calgary Zone and Area
Central Access Healthcare Service
Specialty: Gynecology
Connect Care Department: CALGARY ZONE PEDS GYNE CAT
Estimated time to routine appointment: 3-15 months
Alberta Health Services - Calgary Zone
CENTRAL ACCESS SERVICES
This central access referral service provides a single point of entry for children and adolescents with gynecological problems. The Pediatric and Adolescent Gynecology Clinic provides consultative care for a wide range of gynecological problems in the pediatric population including dysmenorrhea, disorders of sexual development, heavy menstrual bleeding, ovarian cysts, complex contraception, ovarian tissue cryopreservation, long term follow up after gonadotoxic therapy, vulvovaginitis and other vulvar conditions.
This central access referral service provides a single point of entry for children and adolescents with gynecological problems. The Pediatric and Adolescent Gynecology Clinic provides consultative care for a wide range of gynecological problems in the pediatric population including dysmenorrhea, disorders of sexual development, heavy menstrual bleeding, ovarian cysts, complex contraception, ovarian tissue cryopreservation, long term follow up after gonadotoxic therapy, vulvovaginitis and other vulvar conditions.
ELIGIBILITY REQUIREMENTS
  • Children 0 to 17 years of age.
  • Your patient may be seen at either Alberta Children's Hospital or South Health Campus depending on triage.
  • Children 0 to 17 years of age.
  • Your patient may be seen at either Alberta Children's Hospital or South Health Campus depending on triage.
Referral instructions for primary care, community care, private
providers etc. who do not send referrals via Connect Care.
REFERRAL PROCESS - FOR NON-CONNECT CARE USERS
PLEASE NOTE: Referrals are reviewed for completeness prior to acceptance. All referrals are acknowledged, but incomplete referrals will be refused. Please review Eligibility requirements, Referral guidelines and Additional details below before making a referral.

Complete the referral form and fax it to the service using the contact information on this profile.
PLEASE NOTE: Referrals are reviewed for completeness prior to acceptance. All referrals are acknowledged, but incomplete referrals will be refused. Please review Eligibility requirements, Referral guidelines and Additional details below before making a referral.

Complete the referral form and fax it to the service using the contact information on this profile.
REFERRAL PROCESS - FOR CONNECT CARE USERS
PLEASE NOTE: Referrals are reviewed for completeness prior to acceptance. All referrals are acknowledged, but incomplete referrals will be refused. Please review Eligibility requirements, Referral guidelines and Additional details below before making a referral.

Send an Internal Referral using the Ambulatory Referral Order to Gynecology, type CALGARY ZONE PEDS GYNE CAT in the “To Department” section and complete order.
PLEASE NOTE: Referrals are reviewed for completeness prior to acceptance. All referrals are acknowledged, but incomplete referrals will be refused. Please review Eligibility requirements, Referral guidelines and Additional details below before making a referral.

Send an Internal Referral using the Ambulatory Referral Order to Gynecology, type CALGARY ZONE PEDS GYNE CAT in the “To Department” section and complete order.
COMMUNICATION PROCESS
  • Referral receipt to referring source within 7 days.
  • Acceptance via appointment details or wait list status letter to referring source and patient within 14 days.
  • Wait list status update every 90 days.
  • Appointment outcome to referral source within 30 days.
ADDITIONAL SERVICE DETAILS
  • All consults are triaged within 7 days of receipt and urgent referrals are triaged based on the information provided.
  • Some patients may be seen at the South Health Campus location based on triage.
  • Wait times are between 6 - 14 months.
The following reasons for referral should be considered emergent.
Go directly to your nearest hospital. All patients less than 12 years of age will be redirected to Alberta Children's Hospital:
  • Ovarian Torsion
  • Heavy Menstrual Bleeding with Hemoglobin < 80
  • Obstructive Vaginal/Uterine/Hymenal Anomaly with Hematocolpos
  • Vaginal Foreign Body with Battery
For urgent referrals please contact the ACH Switchboard at 403-955-7211 and ask to speak to the Pediatric and Adolescent Gynecologist on call.
If an urgent consult is required, providers can call RAAPID NORTH (patients north of Red Deer) at 1-800-282-9911 or 780-735-0811 or RAAPID SOUTH (patients in and south of Red Deer) at 1-800-661-1700 or 403-944-4486.
The urgency of referral can be changed pending supportive blood work and affect of the condition on daily life such as time lost to school and other activities.  
Wait time is 1 - 3 weeks.
  • All consults are triaged within 7 days of receipt and urgent referrals are triaged based on the information provided.
  • Some patients may be seen at the South Health Campus location based on triage.
  • Wait times are between 6 - 14 months.
The following reasons for referral should be considered emergent.
Go directly to your nearest hospital. All patients less than 12 years of age will be redirected to Alberta Children's Hospital:
  • Ovarian Torsion
  • Heavy Menstrual Bleeding with Hemoglobin < 80
  • Obstructive Vaginal/Uterine/Hymenal Anomaly with Hematocolpos
  • Vaginal Foreign Body with Battery
For urgent referrals please contact the ACH Switchboard at 403-955-7211 and ask to speak to the Pediatric and Adolescent Gynecologist on call.
If an urgent consult is required, providers can call RAAPID NORTH (patients north of Red Deer) at 1-800-282-9911 or 780-735-0811 or RAAPID SOUTH (patients in and south of Red Deer) at 1-800-661-1700 or 403-944-4486.
The urgency of referral can be changed pending supportive blood work and affect of the condition on daily life such as time lost to school and other activities.  
Wait time is 1 - 3 weeks.
 
CENTRAL ACCESS REFERRAL PHONE
403-955-5018
CENTRAL ACCESS REFERRAL FAX
403-476-7759
REFERRAL FORMS
REFERRAL ADVICE
Specialist LINK
PATHWAYS
CENTRAL ACCESS LINKED SERVICES
LINKED SPECIALISTS
CLICK + TO VIEW REFERRAL GUIDELINES
+-
Routine Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Dysmenorrhea
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Education about oral contraception
 
Another option is to try continuous OCP avoiding the pill free interval. This will prevent dysmenorrhea associated with ovulation and menstrual pain
Lifestyle
 
Remind patients to partake in regular exercise. Heat packs and ginger have also been associated with reduction of menstrual pain.
Non-steroidal anti-inflammatory agent
 
Regular NSAIDs (Ibuprofen, Naproxen) can be used prior to the first day of a regular period, and throughout the menstrual cycle. This can improve pain, and also decrease the amount of bleeding days.
Oral contraception
 
Start oral contraceptive pills, recommended higher dose of ethinyl estradiol (EE) to ensure bone development, Brands include Marvelon. Please avoid Alesse or Lolo which have lower levels of EE
The majority of adolescents with dysmenorrhea will respond to the following therapies. We request prior to being seen in the clinic that you try the following suggestions for management.

Please consider re referring your patient if despite conservative therapy they continue to have difficulties with dysmenorrhea
+-
Endometriosis
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
+-
Heavy menstrual bleeding
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Complete blood count without differential
 
Within 3 months
Ferritin measurement
 
Within 3 months
Iron supplement
 
Other (enter your own timing)
Medroxyprogesterone acetate 10 mg oral tablet
 
With anovulation, or irregular cycles, using Provera 10mg po OD x10 days to shed the entire lining every other month to ensure increased regularity of shedding. This can be used prior to starting OCP
Oral contraception
 
Start oral contraceptive pills, recommended higher dose (30-35 mcg) of ethinyl estradiol(EE)ensures bone development, Brands include Marvelon. Please avoid Alesse or Lolo which have lower levels of EE
Pubertal menorrhagia
 
N/A
Tranexamic acid 500 mg oral tablet
 
Please start Tranexamic Acid 1000mg orally TID for heavy bleeding for maximum of 5 days
The majority of adolescents with heavy menstrual bleeding will respond to the therapies listed on the left. We request prior to being seen in the clinic that you try the following suggestions for management.

Please consider re referring your patient if despite conservative therapy they continue to have heavy menstrual bleeding
https://www.albertahealthservices.ca/assets/info/phm/info-phm-ds-pub-dtb-iron-dosing-administration-adults.pdf

Review Abnormal Uterine Bleeding Primary Care Pathway
+-
Intrauterine contraceptive device procedure
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
+-
Irregular periods
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
CBC
 
Within 1 month
Estradiol
 
Within 1 month
FSH
 
Within 1 month
LH
 
Within 1 month
Pelvic Ultrasound
 
Within 1 month
Prolactin
 
Within 1 month
+-
Ovarian cyst
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Suspected benign ovarian cyst

Repeat imaging if last ultrasound or CT scan was completed more than 6 months ago. IF the imaging summary is suspicious or suggestive of a malignancy please call Specialist Link.
+-
Polycystic ovary syndrome
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Review Provincial Polycystic Ovary Syndrome (PCOS) Primary Care Clinical Pathway
+-
Secondary amenorrhea
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Draw the following bloodwork:
  • Luteinizing hormone
  • FSH
  • Estradiol (done on day 3 of cycle if possible)
  • bHCG, TSH, T3, T4
  • Prolactin
 
Within 1 month
Pelvic US to be done in the community
 
Within 1 month
+-
Vulvovaginitis
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
  • Lichen Sclerosis

+-
Urgent Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
+-
Abscess of Bartholin's gland
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
  • If over 12 please send to the closest adult emergency room, IF under 12 please send to pediatric emergency room
+-
Amenorrhea
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Bloodwork including FSH. LH and Estradiol
 
Within 1 month
Pelvic ultrasound
 
Within 1 month
Pelvic MRI to be ordered if Pelvic US shows no uterus/vagina or hematocolpos
 
Within 1 month
No documented uterus
+-
IUD contraception
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
  • Risk of pregnancy (ADHD, impulsive behaviours, FASD, developmentally typical but risk for pregnancy imminent)
  • Please call Specialist Link
+-
Labial tear
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
  • Please go to your closest emergency room

+-
Precocious puberty
Medication List (dose, frequency, route)
 
Within 1 month
Current history and physical including height and weight or growth chart
 
Current
Growth chart with current height and weight
 
Within 6 months
If central precocious puberty suspected (breast development <8y or testicular enlargement <9y) defer bloodwork.
 
Within 3 months
If exaggerated/premature adrenarche suspected (pubic and/or axillary hair, body odor, greasy skin but NO breast enlargement do 8am fasting blood work;*Androgens: Testosterone, DHEAS, Androstenedione and 17-hydroxy-progesterone, Glucose and IGF-1
 
Within 3 months
Xray of left hand and wrist bone age assessment
 
Within 3 months
Pre-pubertal vaginal bleeding

+-
Emergent Reason for Referral
Additional Details
+-
Foreign body in vagina
Vaginal Foreign Body with Battery- confirmation with flat plate xray
+-
Heavy menstrual bleeding
with Hemoglobin < 80
+-
Obstruction of hymen
With lack of menstruation
+-
Obstruction of vagina
Obstructed Vagina/Uterus with Hematocolpos confirmed with imaging 
+-
Ovarian torsion
Confirmed with imaging
If under the age of 12 please send to a pediatric emergency room. If over the age of 12 please send to an adult emergency room.

The primary purpose of the All Locations list is to let the user easily access any location of a healthcare service without going back to the main search screen.

The locations listed have 3 background colors:
  • Green means the healthcare service@location has referral information attached to it.
  • Brown means the healthcare service@location never had referral information attached to it, or it has unpublished referral information.
  • Red means
    • IA changed the healthcare service@location's status to something other than Current
    • It was deleted if it is an ARD healthcare service@location.
Green  and Brown are always at the top of the list. These are the Healthcare Service@Locations with the status of Current.
The Red list at the bottom consists of non-current Healthcare Service@locations that once had Published referral information in the ARD.
If the referral information was never published in ARD the Healthcare Service@location will not show in the Red list.

The secondary purpose of the All Locations list is to allow ARD Administrators to recover (copy) referral information from the non-current Healthcare Service@Locations to ones that are current.

Common Scenario:
A Healthcare Service moves from one location to another. In this case the IA Healthcare Service@Location record will be made defunct (non-current) and a new Healthcare Service@Location record will be created with a current status. In this scenario the captured referral guidelines in ARD can become "orphaned" as they are not attached to any current IA healthcare service.

Categories of non-current or orphaned referral guidelines: INDIVIDUAL and COMMON.
The REFERRAL GUIDELINES section of the profile has the prefix INDIVIDUAL or COMMON to help you choose the method below when transferring referral guidelines from a non-current Healthcare Service@Location to a current healthcare service@location.

Individual referral process
  1. Click on a non-current (Red) Healthcare Service@Location at the bottom of the All Locations list.
  2. The non-current referral info is displayed with the link Copy this Referral Process to another Healthcare Service@Location link on the upper right hand corner. Click on the copy link.
  3. Choose a current location (Green or Brown) from the All Locations list. This will be the Healthcare Service@Location you are pasting the referral info into.
  4. The system will display the Edit Referral Info screen populated with the referral info from the non-current Healthcare Service@Location you viewed in the first step.
  5. Click Save and the referral info is transferred from the non-current Healthcare Service@Location to the current one.
  6. Repeat these steps for each Healthcare Service@Location that needs attention.

Common referral process - 2 sub cases.
Case 1: At least 1 current Healthcare Service@Location with common referral info is with current status for this healthcare service; One or more Healthcare Healthcare Service@Locations where replaced by new one.
  1. Click on any current Healthcare Service@Location whether it has referral info (Green) or not (Brown).
  2. The healthcare service location opens in the Edit Referral Info screen populated with the current common referral info.
  3. Save it. 
  4. All locations will be updated with the common referral information, including all the locations that don't have referral info yet (Brown). The non-current referrals (Red) will also be updated.
Case 2:  All Healthcare Healthcare Service@Locations for a healthcare service are set to a non-current status and replaced by new ones. In this case there is no current additional referral info to copy from, so the only alternative is to pick up the non-current common referral process (Red). Follow the steps described in the section Individual Referral Process above to copy/paste the non-current common referral info to the current healthcare service locations.
Generally we want to replicate current common referral info to new or replaced healthcare service locations. We only resort to copying non-current common referral info if there is no other option.

Remember: Some fields can be location specific with the common referral process:
Parking Instructions, Directions, Parking Map, Wait Time, Referral Phone or Referral Fax.
To update these items you have to edit each Healthcare Service@Location separately.

ADDITONAL NOTES:
  • The info icon after the All Locations drop down will be visible to ARD Administrators.
  • The system doesn't allow you to copy referral information from one non-current Healthcare Service@Location to another.

 

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