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 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

Change in bowel habit with any of the following red flags:

  • bloody stools - not thought to be infectious gastroenteritis, consider contacting gastroenterology registrar on call to discuss
  • nocturnal diarrhoea awaking the patient from sleep
  • elevated faecal calprotectin
  • weight loss ≥ 10% in prior 3 to 6 months
  • palpable abdominal mass
  • iron deficiency with or without anaemia
  • abnormal imaging
  • fever or other abnormal pathology results (elevated C-reactive protein (CRP))

Category 2 — appointment clinically indicated within 90 days

  • relevant patient or family history of bowel cancer or inflammatory bowel disease

Category 3 — appointment clinically indicated within 365 days

  • progressive or persistent symptoms despite medical management without alarms
  • sub-optimally controlled chronic issues for ongoing management

For information on referral forms and how to import them, please view general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements


  • description of symptoms, including stool frequency/consistency/character, duration of symptoms
  • presence and nature of any red flags:
    • bloody stool not thought to be infectious gastroenteritis
    • nocturnal diarrhoea awaking the patient from sleep
    • weight loss
    • palpable abdominal mass
    • iron deficiency
  • medical management to date, document treatments offered and efficacy including failed dietary/pharmacology intervention
  • complete list of medications including over the counter medications (OTC)
  • recent antibiotic use, previous radiation therapy or gastrointestinal (GI) surgery
  • patient and family history of GI malignancy
  • recent travel, illness in other family members


  • abdominal and digital rectal examination findings, note sphincter tone


  • complete blood examination (CBE)
  • urea, electrolytes, and creatinine (UEC)
  • liver function tests (LFT)
  • iron studies if haemoglobin (Hb), mean corpuscular volume (MCV) or mean corpuscular haemoglobin are low
  • thyroid function tests (TFT)
  • coeliac serology (persistent loose stools)
  • faecal calprotectin if loose stools for > 6 weeks
  • stool pathogen testing (acute diarrhoea)
  • previous investigations and reports, e.g. sigmoidoscopy, rectal biopsy, colonoscopy
  • clostridium difficile toxin if recent antibiotic use

Additional information to assist triage categorisation

Relevant mental health, and or stress issues especially if irritable bowel syndrome (IBS) is suspected.

Clinical management advice

Most people with altered bowel habits without red flags will simply have constipation, irritable bowel syndrome (IBS) or functional diarrhoea.

A structured clinical history paying attention to the time course, age of the patient and excluding relevant alarms will make most diagnoses simple and allow you to manage safely in primary care. Refer to useful resource section for further information.

Please be aware that review of sub-optimally controlled chronic issues for management advice may be completed utilising nurse or allied health led written resource/s or clinics.

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

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.

Clinical resources

Consumer resources