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 bowel obstruction – vomiting, significant distention, lack of passage of flatus, obstipation
  • acute surgical pathology e.g. evidence of peritonism, systemic toxicity
  • acute severe ulcerative colitis ≥ 6 bloody bowel stools per 24 hours (Truelove and Witts criteria) as well as any of the following:
    • temperature > 37.8°C
    • pulse rate > 90 bpm
    • haemoglobin (Hb) < 105 g/l
    • C-reactive protein (CRP) > 30mg/L at presentation or erythrocyte sedimentation rate (ESR) > 30 mm

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • abdominal pain with the following red flags:
    • weight loss ≥ 10% in previous 3 to 6 months
    • past history of intra-abdominal malignancy within the last 5 years
    • iron deficiency or other abnormal blood tests (haemoglobin (Hb), C-reactive protein (CRP))
    • abdominal mass on examination
    • abnormal imaging
    • nocturnal symptoms disturbing sleep
  • positive immunological faecal occult blood testing (iFOBT )/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH) - refer to 'Colorectal Cancer Screening - Adult CPC'

Category 2 — appointment clinically indicated within 90 days

  • relevant family history of cancer

Category 3 — appointment clinically indicated within 365 days

  • nil

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.

History

  • detailed description of the abdominal pain including site, radiation, severity, character, pattern, precipitating or relieving factors, duration of symptoms, associated symptoms, functional impact
  • presence or absence of red flags:
  • progressive symptoms
  • fever
  • weight loss
  • change in bowel habits
  • bloody stools
  • abdominal mass
  • anaemia
  • past relevant medical history, including past gastrointestinal (GI) cancer, abdominal surgery
  • current medication especially nonsteroidal anti-inflammatory drugs, opioids, anti-depressants, selective serotonin reuptake inhibitors (SSRIs), anticoagulants, antiplatelets
  • family history of GI disease in first degree relative – irritable bowel syndrome (IBS), cancer, polyp, inflammatory bowel disease (IBD)
  • mental health and/or chronic pain issues
  • drug and alcohol consumption

Examination

  • examination findings – body mass index (BMI), abdominal and digital rectal examination (DRE)

Investigations

  • complete blood examination (CBE)
  • urea, electrolytes, and creatinine (UEC)
  • liver function tests (LFT)
  • C-reactive protein (CRP), if IBD suspected
  • iron studies
  • faecal calprotectin if diarrhoea > 6 weeks

Additional information to assist triage categorisation

Previous investigations and reports of presenting abdominal pain, e.g. endoscopy, radiological reports.

Clinical management advice

Most abdominal pain is functional in nature or related to bloating, and constipation. This resolves with attention to diet, exercise and stress and often does not require specialist medical input.

It is always worth considering the possibility of pregnancy as a cause for symptoms.

Most cases where specialist review is indicated will be clearly identified by the presence of other red flags.

Abdominal pain alone is a low yield indication for colonoscopy, so unless there is a positive immunological faecal occult blood testing (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH), referrals for this indication are not likely to be accepted.

Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician to discuss your concerns.

If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.

Refer to relevant CPC for:

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.