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.

  • nil

For clinical advice, please telephone the relevant specialty service.

Women's and Children's Health Network

Exclusions

  • normal coeliac serology regardless of HLA DQ2 or DQ8 typing, exception if immunoglobulin A (IgA) deficient
  • positive HLA DQ2 or DQ8 typing and normal coeliac serology, exception if IgA deficient

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • suspected coeliac disease with any of the following:
    • tissue transglutaminase IgA (TTG IgA) > 10 x upper limit normal (ULN)
    • iron deficiency anaemia
    • faltering growth with weight loss of > 2 weight percentiles

Category 2 (appointment clinically indicated within 90 days)

  • suspected coeliac disease with tissue transglutaminase IgA (TTG IgA) 2-10 x ULN
  • suspected coeliac disease in the presence of IgA deficiency (< 0.2 g/L)

Category 3 (appointment clinically indicated within 365 days)

  • known coeliac 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 2 weight measurements, with percentiles
    • any weight loss, including amount and timeframe
    • medical history, medications, allergies, immunisations
  • investigations including:
    • tissue transglutaminase immunoglobulin A (TTG IgA) on gluten-containing diet for > 6 weeks
    • total IgA

Additional information to assist triage categorisation

  • family history of coeliac disease and/or autoimmune disease
  • full blood count (FBC)
  • iron studies
  • endomysial antibodies IgA

Clinical management advice

Serology testing should be done during a period of gluten-containing dietary intake.

Continue gluten-containing diet until initial review or withdraw gluten and advise patient that reintroduction of gluten may be required for further testing.

All patients with suspected coeliac disease should be referred to a gastroenterologist for confirmation of diagnosis and counselling.

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 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.