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.

  • severe symptomatic anaemia with:
    • acute overt gastrointestinal (GI) bleeding
    • chest pain
    • dyspnoea
    • haemodynamic instability e.g., shock, hypotension, syncopal episodes

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

Inclusions

  • iron deficiency anaemia with gastrointestinal symptoms and/or suspected gastrointestinal cause

Exclusions

  • all other presentations of iron deficiency should be referred first to Paediatric Medicine, see Iron Deficiency - Paediatric Medicine CPC
  • iron deficiency without anaemia, in the absence of positive coeliac serology and/or elevated calprotectin > 500mcg/g

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • iron deficiency with positive coeliac serology
  • iron deficiency with elevated calprotectin > 500mcg/g

Category 2 (appointment clinically indicated within 90 days)

Category 3 (appointment clinically indicated within 365 days)

  • nil

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.

  • past medical history – please provide any relevant features as relating to triage categories
  • family history including gastrointestinal/colorectal cancer, coeliac disease, inflammatory bowel disease (IBD)
  • dietary history
  • medications, allergies and immunisations
  • details of presenting condition including:
    • symptoms, including frequency, severity and duration
    • sensory and texture issues with food, if any
    • food avoidance/restricted eating patterns, if any
    • associated symptoms, e.g. dysphagia, eczema, asthma, prolonged illness/infection
    • presence of concerning features
    • oral supplementation trialled, including doses and duration and response
  • pathology:
    • complete blood examination (CBE)
    • electrolytes, urea, creatinine (EUC)
    • liver function tests (LFTs)
    • iron (Fe) studies
    • coeliac serology
    • thyroid function tests (TFTs)
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • faecal calprotectin
    • faecal multiplex polymerase chain reaction (PCR)
    • stool microculture and sensitivities (MCS)

Additional information to assist triage categorisation

  • dietitian summary/report, if available
  • 3-day food chart
  • current weight and length or height, with percentiles
  • growth chart trends including at least two weight measurements, with percentiles
  • blood pressure trends
  • abdominal examination findings
  • relevant diagnostic/imaging reports – including date and location of imaging

Clinical management advice

Helicobacter pylori (H. pylori) is rarely a cause for recurrent abdominal pain or pathogenic in children and should not be screened for on a routine basis. It should only be screened for if there is concern about peptic ulcer disease or there is a family history of gastric cancer in a first degree relative.

In the case of a peptic ulcer this should warrant referral to Gastroenterology.

Refer also to Paediatric Medicine Iron Deficiency – Paediatric CPC.

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.