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.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Regional health networks 

Category 1 — appointment clinically indicated within 30 days

  • positive faecal immunochemical test (immunological faecal occult blood testing (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH))

Category 2 — appointment clinically indicated within 90 days

  • asymptomatic 45 to 74 years of age with high-risk family history, for colonoscopy screening including:
    • first degree relative of known familial adenomatous polyposis (FAP) antibody individual (adenomatous polyposis coli (APC) gene mutation)
    • first degree relative of known individual with Lynch syndrome
    • first degree relative of known individual with Lynch-like syndrome
  • sibling of individual with MUTYH mutation or proven serrated polyposis syndrome
  • people with possible high-risk syndrome, including:
    • signs of possible Peutz Jaegers e.g. buccal markings
    • signs of FAP e.g. atypical congenital hypertrophy of the retinal pigment epithelium

Category 3 — appointment clinically indicated within 365 days

  • people age 40 to 74 years with moderately increased risk  — asymptomatic people with one first-degree relative diagnosed with bowel cancer under age 60, or two first-degree relatives diagnosed with bowel cancer at any age, or a combination of the two — for colonoscopy screening as per National Health and Medical Research Council (NHMRC) guidelines

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

  • indication for screening procedure, including family and personal history/positive immunochemical faecal occult blood test (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH)
  • patient and family history of bowel or gastrointestinal (GI) cancer, including age at diagnosis, precise relationship to the patient, e.g. first degree relative, second degree etc.
  • past relevant medical history, including significant cardiovascular, respiratory, renal or liver disease and surgery, particularly abdominal surgery
  • current medication, especially non-steroidal anti-inflammatory drugs (NSAIDs), opioids, anti-depressants, selective serotonin reuptake inhibitors (SSRIs), anticoagulants, antiplatelets, diabetes medication
  • frailty, mobility, falls risk, cognitive function, ability to use a digital “self-service” pathway

Examination

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

Investigations

  • complete blood examination (CBE)
  • urea, electrolytes, creatinine (UEC)
  • liver function tests (LFTs)
  • relevant previous imaging, endoscopic, histology reports

Charlson co-morbidity index

Age May have one of the following (1 point) May not have any of the following
75 to 79 years of age
(3 points for age alone)		 - mild liver disease
- diabetes without end-organ damage
- cerebrovascular disease
- ulcer disease
- connective tissue disease
- chronic pulmonary disease
- dementia
- peripheral vascular disease
- congestive heart failure
- myocardial infarction
 - moderate/moderate/severe liver disease
- diabetes with end-organ damage
- hemiplegia
- moderate or severe renal disease
- acquired immunodeficiency syndrome (AIDS)
- metastatic/non-metastatic solid organ or haematopoietic malignancy
≥ 80 years
(4 points for age alone)
 May not have any of above medical conditions - 

Clinical management advice

For Colorectal Cancer High Risk Surveillance, refer to Colorectal Cancer High Risk Surveillance — Colorectal Surgery Adult CPC.

The recommended strategy for population screening in Australia per National Health and Medical Research Council (NHMRC) guidelines, directed at those at average risk of colorectal cancer and without relevant symptoms, is immunochemical faecal occult blood test (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH) every two years, starting at age 45 years, and continuing to age 74 years:

  • People aged 45 to 49 are required to request a free bowel cancer screening kit
  • People aged 50 to 74 receive a bowel cancer screening kit in the post every 2 years

Patients outside the recommended age for Colorectal Cancer (CRC) screening as per NHMRC guidelines, e.g. over 75 years of age, need to have their fitness for colonoscopy assessed against the Charlson score prior to referral. See referral information.

As CRC screening in otherwise healthy individuals is now a safe, effective, and routine practice, several sites in South Australia are now moving to the use of digital patient pathways for the triage and progression of referrals more directly through to colonoscopy. This improves efficiency and shortens waiting times to colonoscopy procedures for the right people. It is vital that general practitioners (GPs) provide as accurate a history as possible to enable safe and accurate triage to support this gain in care delivery. See Facilitated Access Colonoscopy CPC for further information.

National standards recommend a colonoscopy, or other total colonic examination is performed within 120 days of an appropriately performed iFOBT, FIT or FHH.

If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician or Gastroenterology Registrar on call to discuss your concerns.

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.