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.

  • suspected or known inflammatory bowel disease with severe abdominal pain and/or bloody diarrhoea, and any of the following features:
    • fever
    • haemodynamic compromise
    • suspected megacolon
    • suspected bowel perforation
    • bowel obstruction
    • abscess, abdominal or perianal
    •  haemoglobin (Hb) < 90 g/L

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • bloody diarrhoea in the presence of bacterial infection found on stool multiplex polymerase chain reaction (PCR)
    Note: If persisting positive Clostridium difficile (C. difficile) PCR despite optimal antibiotic therapy, discuss with Infectious Diseases and send referral through to Gastroenterology regardless with information stated.

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected or known inflammatory bowel disease where chronic diarrhoea, bloody or non-bloody, or other symptoms > 4 weeks with elevated faecal calprotectin (> 250 mcg/g), and any of the following critical features are present:
    • new progressive gastrointestinal symptoms, e.g. abdominal pain, vomiting
    • faltering growth, i.e. weight loss of ≥ 2 weight percentiles
    • perianal pain or fistulae suspected
    • significant abnormality to one or more of the following laboratory critical features:
      • anaemia
      • low albumin
      • elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
      • iron deficiency
      • holotranscobalamin (active vitamin B12) deficiency
    • abnormal imaging suggesting inflammatory bowel disease

Category 2 (appointment clinically indicated within 90 days)

  • suspected inflammatory bowel disease where chronic diarrhoea (non-bloody) or other symptoms > 6 weeks with elevated faecal calprotectin (> 100 mcg/g), and none of the above critical features are present
  • known inflammatory bowel disease with a flare of symptoms, and none of the above critical factors are present

Category 3 (appointment clinically indicated within 365 days)

  • known inflammatory bowel disease for routine follow-up

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.

  • details of presenting condition including:
    • onset and duration of symptoms
    • frequency and severity of symptoms
  • medical management to date / treatment trialled and response
  • clinical history including:
    • current weight and length or height, with percentiles
    • growth chart trends including at least two weight measurements, including percentiles
    • any weight loss, including amount and timeframe
    • medical history, medications, allergies, immunisations
  • investigations including:
    • stool multiplex polymerase chain reaction (PCR) negative, and Clostridium difficile toxin
    • faecal calprotectin result (in children aged > 4 years)
    • full blood count (FBC)
    • liver function test (LFT) result
    • electrolytes, urea and creatinine (EUC)
    • iron (Fe) studies
    • holotranscobalamin (active vitamin B12)
    • c-reactive protein (CRP)
    • relevant imaging reports, including date and location of imaging
    • current and previous colonoscopy results, if available

Additional information to assist triage categorisation

  • personal or family history of inflammatory bowel disease

Clinical management advice

Faecal calprotectin levels can be elevated in healthy, pre-school aged children and should be interpreted with caution.

Clinical resources

Consumer 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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.