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 haematemesis or melaena
  • acute lower gastrointestinal bleeding in large volume or with haemodynamic compromise
  • acute severe colitis, > 6 bloody bowel motions per 24 hours

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

  • non-significant haematochezia, i.e. small, fresh rectal bleeding on wiping, responsive to trial of laxatives
  • thriving infant with minor rectal bleeding, i.e. food protein-induced allergic proctocolitis (FPIES)
  • allergic proctocolitis
    Note: not out of scope if tertiary referral from paediatrician
  • rectal bleeding, small volume, in the setting of formed stools – 6 week trial of appropriate stool softener
    Note: if bleeding persists despite this trial, referral should be made

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • persistent haematemesis, melaena or rectal bleeding with any of the following features:
    • faltering growth (weight loss of > 2 weight percentiles)
    • iron deficiency anaemia
    • persistent diarrhoea (bloody or non-bloody) > 6 weeks
    • significantly elevated inflammatory markers — raised platelet count, C-reactive protein, erythrocyte sedimentation rate and/or reduced albumin

Category 2 (appointment clinically indicated within 90 days)

  • persistent haematemesis, melaena or rectal bleeding without any of the above features

Category 3 (appointment clinically indicated within 365 days)

  • suspected colonic polyp with minimal rectal bleeding

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 two weight measurements, with percentiles
    • any weight loss, including amount and timeframe
    • medical history, medications, allergies, immunisations
  • investigations including:
    • full blood count (FBC)
    • liver function test results (LFTs)
    • iron (Fe) studies
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • coagulation studies

Additional information to assist triage categorisation

  • faecal multiplex polymerase chain reaction (PCR) results
  • faecal Helicobacter pylori antigen
  • faecal calprotectin result if diarrhoea > 6 weeks (in children aged ≥ 4 years)
  • previous investigations and reports, e.g. endoscopy, radiological reports, if available

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.