Breadcrumbs

Colorectal Surgery outpatient service in Central Adelaide

The Central Adelaide Colorectal Surgical Units of the Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH) provides inpatient and outpatient services for patients living in the Central Adelaide Local Health Network area who suffer from colorectal surgical disorders as well as a tertiary referral service for complex colorectal conditions from both South Australia and interstate.

Services are also provided to patients referred from rural and remote areas.

Children aged less than 18 years of age are usually managed by paediatric surgeons with referral to the Women’s and Children’s Hospital. For those between the ages of 15 and 18 years, discussion with both adult and paediatric surgeons may be appropriate to determine the most appropriate referral pathway.

Contact details – outpatients

Royal Adelaide Hospital

Clinic fax (for referrals): (08) 7074 6247

Appointment enquiries and new case appointments

Outpatient area: (08) (08) 7074 6247

Review or change of appointments

Outpatient Call Centre: 1300 153 853

The Queen Elizabeth Hospital

Clinic fax (for referrals): (08) 8222 7244

Appointment enquiries, changes, reviews and treatment

(08) 8222 7010 / (08) 8222 7030 / (08) 8222 7040

Review or change of appointments

(08) 8222 7010 / (08) 8222 7030

Appointment location – outpatients

Royal Adelaide Hospital

Level 3, Outpatient Department
Royal Adelaide Hospital
North Terrace SA 5000

The Queen Elizabeth Hospital

Ground floor, Outpatients area 1
The Queen Elizabeth Hospital
28 Woodville Road, Woodville South SA 5011

Services and clinics available

Services provided are:

  • Outpatient clinic consultations for diagnosis and management
  • Inpatient consultations
  • Inpatient admission
  • Colonoscopy

Colorectal outpatients

The objective of patients visiting colorectal surgical outpatients is for the assessment of semiacute and chronic conditions of the colon rectum and anus. Patients with acute surgical conditions requiring emergency attention should be referred to an accident and emergency department.

Patients will be prioritsed as to the urgency of the condition. It is important that a detailed referral note is produced to enable effective triage of patients.

Patients may be triaged to an Ezi Access colonoscopy clinic or PR bleeding clinic (gastrointestinal bleeding) if suitable (see colorectal surgical priorities based on clinical urgency below).

The outpatients department are under consultant surgical supervision. Patients may be seen by consultant or trainee surgeons with management as per unit protocols. Any difficult patient diagnostic or management decisions will be made in discussion with the clinics consultants.

Royal Adelaide Hospital (RAH)

Day Clinic (RAH) Doctors Conditions seen
Monday
am
Surgical
e-colorectal
Colorectal support
None
General colorectal
  
Tuesday
am
Surgical
e-colorectal
Dr Matthew Lawrence (alternate weeks)
Dr Michelle Thomas(alternate weeks)
Dr Mark Lewis (weekly)
RMO (weekly)  
Rectal bleeding (once a month)
Stomal therapy (weekly)
Nurse led
General colorectal





Specialised rectal bleeding
 
Tuesday
pm
  Dr Matthew Lawrence (alternate weeks)
Dr Michelle Thomas (alternate weeks)
Dr Mark Lewis (every week)
Faecal incontinence
Dr Michelle Thomas
(once every 2 months)
General colorectal





Specialised clinic for faecal incontinence
Wednesday No clinics    
Thursday
am
Surgical
e-colorectal (alternate weeks)
Dr Andrew Hunter General colorectal
Friday
pm
  Stomal therapy incontinance nurse Specialised nurse led clinic for faecal incontinence

Bulk bill clinics: (named referral required)

No bulk bill clinics are conducted at the RAH for colorectal clinics.

The Queen Elizabeth Hospital (TQEH)

Day Clinic (TQEH) Doctors Conditions seen
Monday No clinics    
  
Tuesday Colorectal Professor Peter Hewett
Registrar
 
Wednesday No clinics    
Thursday Colorectal Mr Shanthan Ganesh
Laparoscopic fellow
Registrar
Stomal nurse
 
Friday Colorectal Mr David Roddda
Mr Darren Tonkin
A/Professor N Rieger
(week B/D)
Mr Shanthan Ganesh
(week A/C)
Registrar
 

Bulk bill clinics: (named referral required)

No bulk bill clinics are conducted at the TQEH for colorectal clinics.

Referral process

Immediate referral process

Where consultation is 'same day' urgent, the colorectal registrar can be contacted or the on call surgical registrar if after hours, should be contacted via the Queen Elizabeth Hospital (TQEH) (08) 8222 6000 or Royal Adelaide Hospital (RAH) switchboard (08) 7074 0000 to discuss the patient.

A written referral marked URGENT should then be faxed to:
TQEH: (08) 8222 7244
RAH: (08) 7074 6247 
or sent with the patient if urgent assessment arranged. If the condition is life-threatening, the patient should be sent to the nearest emergency department.

Less urgent referrals

All referrals including those urgently requiring consultation must be in writing. Preferred method of referral is by fax or letter.

Fax number:
TQEH: (08) 8222 7244
RAH: (08) 7074 6247 

All referrals will be triaged by a consultant member of the colorectal surgical service. Non-urgent referrals will be allocated to the next available appointment. Non-urgent referrals may incur a wait. The waiting time for appointment will vary and be dependent on the demand for this service and the urgency of the patient’s condition.

Colorectal surgical problems not considered high priority (see eligibility and referral criteria) may wait a longer time for an appointment. Please consider other options and do not refer to multiple providers regarding the same presenting complaint.

Should changes occur to a patient’s medical condition during the waiting time for an appointment, referrers should send updated clinical information.

Clinical features indicative of potentially serious pathology

  • Patients who have a palpable abdominal mass, malignant mass on rectal (PR) examination, radiological evidence of carcinoma or intra-abdominal abscess/sepsis.
  • Atypical rectal bleeding (including dark, admixed, associated with sustained altered bowel habit or significant weight loss).

Referrals unlikely to be offered an appointment

  • Referrals for cosmetic or dermatological anal conditions.
  • Longstanding symptoms such as chronic abdominal pain (especially when previously investigated).

Referrals for chronic constipation or chronic diarrhoea suggestive of irritable bowel syndrome should be directed to gastroenterology outpatients.

For further information on eligibility and referral processes see the outpatient referral process page.

Alternate care options/health information for low priority conditions while waiting for an appointment or if no appointment is made

Most cases, the key to appropriate management is a detailed history and examination. Options for obtaining further information regarding various colorectal conditions and to provide guidance for assessment, investigations and management are listed under colorectal surgical clinical information sheets below. In some instances, links to fact sheets have been included in the table which outlines clinical criteria for referral.

Post discharge guidelines and information

If the patient or their general practitioner is concerned about a deterioration in the medical condition (see clinical information sheets and table of clinical features indicative of potentially serious pathology) and colorectal assessment is required earlier than planned, a phone call requesting a colorectal registrar, or the on call surgical registrar if after hours, should be made via the Queen Elizabeth Hospital (TQEH) (08) 8222 6000 or Royal Adelaide Hospital (RAH) switchboard (08) 7074 0000 to discuss the patient.

Patients whose condition has stabilised or resolved and for whom no further appointment has been made will be formally discharged. If an assessment is required again, a new referral, preferably a named referral (see consultant list) should be faxed to the colorectal surgical unit at TQEH (08) 8222 7244 or RAH (08) 7074 6247.

Follow up after bowel cancer surgery

The Colorectal Unit has instituted the use of a dedicated bowel cancer support nurse to help manage the patient journey after diagnosis and treatment of bowel cancer. This program has proved highly successful in many respects but most importantly has ensured a high level of compliance with best practice outcomes in follow-up of such patients.

It is widely recognised that the diagnosis of recurrent disease is most commonly made on biochemical (CEA) and radiologic (CT scanning) rather than on clinical grounds. Whereas previously we would ask to see these patients in the clinic every six months (with GP visits in the 'off' three months in the first two years), we now recommend six monthly clinical review by the patients general practitioner only. The ongoing need for regular CEA monitoring (three monthly for two years then six monthly to five years post op), radiologic and appropriate colonoscopic follow-up will rest with the hospital based bowel cancer support nurse. All tests will be ordered and reviewed by the support nurse and the GP does not need to perform any tests routinely unless there are concerns. The results of these investigations will be communicated to the patient’s GP in a timely fashion.

Colorectal surgical priorities are based on clinical urgency as displayed below

Priority Examples (not an exhaustive list) Referral process
Immediate
Colorectal emergencies with threat to life.
Direct to an emergency department.
Acute abdomen / peritonitis or bowel obstruction.
Septic conditions requiring surgical intervention such as acute intrabdominal or severe perianal sepsis
To nearest emergency department.
Urgent Diagnosed colorectal or anal malignancy, complicated diverticular disease (imaging proven), non acute anorectal sepsis such as anal fistula. Monday to Friday 9.00 am to 5.00 pm. Can be discussed with the colorectal surgical registrar on call via TQEH (08) 8222 6000 or RAH switchboard (08) 7074 0000 to obtain appropriate prioritisation and then a referral letter marked URGENT faxed to (08) 7074 6247.
After hours: medical registrar on call via TQEH (08) 8222 6000 or RAH switchboard (08) 7074 0000.
Semi urgent
Condition is unlikely to require more complex care if assessment is delayed
Condition has the potential to have some impact of quality of life is care is delayed
PR bleeding or alteration in bowel habit suggestive of malignancy, inflammatory bowel disease not controlled by medical therapy. Referrals should be faxed to TQEH (08) 8222 7244 or RAH (08) 7074 6247.
 
Intermediate
Condition is unlikely to deteriorate quickly.
Condition is unlikely to require more complex care if assessment is delayed.
Anal fistula, uncomplicated diverticulitis, rectal prolapse, faecal incontinence, bright rectal bleeding (see rectal bleeding clinic). Referrals should be faxed to TQEH (08) 8222 7244 or RAH (08) 7074 6247.
Non-urgent
Low priority
Uncomplicated haemorrhoidal presentations, pilonidal disease, anal tags. Referrals should be faxed to TQEH (08) 8222 7244 or RAH (08) 7074 6247.
Note: It is important to note these guidelines indicate what is clinically desirable, not what is always feasible in terms of delivery which is dependent on size and staffing of the hospital department.

Colorectal clinical information sheets

The following information sheets about presentations commonly seen in colorectal clinics provide the minimum information required for assessing a referral under the headings of eligibility, priority, differential diagnosis, clinical information and investigations required, pre-referral management strategies and discharge criteria.

 

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