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.

  • concerns of systemic infection including:
    • febrile greater than 38°
    • haemodynamic instability
  • ongoing high output stoma with clinical signs of dehydration or acute renal impairment
  • peri-stomal bleeding
  • peri-stomal cellulitis
  • severe/uncontrollable pain unresponsive to first-line management
  • stomal change in colour from red/pink to blue or black
  • stomal prolapse causing circulatory compromise
  • suspected bowel obstruction/non-functioning stoma, potential symptoms include
    • inability to pass any bowel motions or gas
    • significant change in bowel habits
    • distended abdomen, abdominal pain and cramping
    • nausea/vomiting

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Patients who have concerns related to stomal appliances can seek assistance from stomal therapy nurses if they are already connected to a service. If patients are not currently in contact with stomal therapy services, they can be referred by their general practitioner (GP).

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • high volume stoma output unresponsive to first-line management
  • peri-stomal complications including bleeding/granuloma/dermatitis/pressure injury/wound
  • poor fitting/leaking stoma appliances
  • suspected pyoderma gangrenosum
  • parastomal hernia

Category 2 (appointment clinically indicated within 90 days)

  • additional appliance consideration for people who have exhausted stoma appliance scheme funding

Category 3 (appointment clinically indicated within 365 days)

  • annual routine stoma review

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/surgical history – including site and service where stoma was created
  • medications and allergies
  • presenting symptoms
    • stoma output, frequency
    • stool texture, for example soft, watery, hard
    • aperients if needed, including microlax/suppository use/frequency
    • fluid volume intake/output (ileostomy/urostomy)
    • previous management trialled and outcomes
  • abdominal examination
  • abdominal Xray if concerns of constipation or faecal loading
  • reports of prior colonoscopies and pathology of specimens removed
  • relevant diagnostic/imaging reports, including location of company and accession number

Clinical management advice

Patients who have concerns related to stomal appliances can seek assistance from stomal therapy nurses if they are already connected to a service. If patients are not currently in contact with stomal therapy services, they can be referred by their general practitioner (GP).

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.