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.

  • acute severe colitis (> 6 bloody bowel motions per 24 hours)
  • dehydration unable to be managed at home
  • suspected bowel obstruction – bilious vomiting, significant distention, lack of passage of flatus, obstipation

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

  • allergic colitis
  • non-tertiary referrals for chronic constipation and encopresis – refer to Constipation/Encopresis - Paediatric Medicine CPC
    Note: tertiary referral from paediatrician or paediatric surgeon accepted
  • positive stool multiplex polymerase chain reaction (PCR) for infection
    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.
  • self-limiting diarrhoea < 6 weeks

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • persistent diarrhoea (bloody or non-bloody) > 4 weeks with any of the following features:
    • negative stool multiplex PCR for infection
    • faltering growth, weight loss of > 2 weight percentiles
    • significantly elevated inflammatory markers – raised platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and/or reduced albumin
    • tissue transglutaminase immunoglobulin A (TTG IgA) > 10 x upper limit normal (ULN)
    • elevated faecal calprotectin > 500 mcg/g

Category 2 (appointment clinically indicated within 90 days)

  • persistent diarrhoea > 4 weeks without any of the above features

Category 3 (appointment clinically indicated within 365 days)

  • tertiary referral, i.e. paediatrician or paediatric surgeon, for treatment resistant constipation or encopresis
    Note: non-tertiary referrals for constipation/encopresis should be directed in the first instance to Paediatric Medicine, see Constipation/Encopresis - Paediatric Medicine CPC

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 the presenting condition including:
    • onset, duration, 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, with percentiles
    • any weight loss, including amount and timeframe
    • medical history, medications, allergies, immunisations
  • investigations including:
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • faecal multiplex polymerase chain reaction (PCR) result
    • faecal calprotectin result, in children aged > 4 years with diarrhoea > 4 weeks
    • full blood count (FBC)
    • iron (Fe) studies
    • liver function test (LFT) results
    • coeliac serology: tissue transglutaminase immunoglobulin A (TTG IgA), total IgA where possible, with or without anti-endomysial antibody (EMA).

Additional information to assist triage categorisation

  • any previous investigations and reports – including date and location of imaging, e.g. endoscopy, radiological reports

Clinical management advice

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

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 General Practitioners role 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 General Practitioner once the transfer of care has occurred.