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/uncontrolled abdominal and/or rectal pain unresponsive to first-line management
  • significant or uncontrolled per rectum (PR) bleeding
  • suspected bowel obstruction 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 colorectal or general surgery on-call registrar to discuss your concerns prior to or at the time of referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • suspected malignancy
  • palpable rectal mass suspicious for colorectal cancer (CRC)
  • imaging suspicious of CRC
  • rectal bleeding with any of the following concerning features:
    • dark blood coating or mixed with stool
    • unexplained weight loss of at least 5% of body weight in previous 6 months
    • palpable of or visible abdominal/rectal mass
    • iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
    • patient and family history of bowel cancer, 1st degree relative less than 55 years old
    • new change in bowel habit
    • new tenesmus

Category 2 (appointment clinically indicated within 90 days)

  • a high level of suspicion of CRC because of an unexplained sign or symptom but not meeting the above criteria

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.

  • smoking/alcohol and other drug status
  • age
  • presenting symptoms:
    • concerning features
    • previous management trialled and efficacy - including previous admission/s to hospital

History

  • detailed history of bleeding including volume, frequency, duration, bowel habit, constipation, straining, associated bowel symptoms, blood alone or mixed with stools, clots, mucous, tenesmus, recurrent per rectum bleeding previously investigated
  • patient and family history of gastrointestinal disease including age at diagnosis, precise relationship to the patient/family tree including cancer, specimens , inflammatory bowel disease, coeliac disease, irritable bowel syndrome, haemorrhoids
  • past relevant medical history, including significant cardiovascular, respiratory, renal or liver disease and surgery, particularly abdominal surgery
  • dietary history if iron deficient
  • menstrual history if iron deficient and female
  • current medication, especially nonsteroidal anti-inflammatory drug, opioids, anti-depressants, selective serotonin reuptake inhibitors (SSRIs), anticoagulants, antiplatelets, diabetes medication
  • frailty, cognitive function, ability to use a digital “self-service” pathway
  • examination findings
    • body mass index
    • abdominal and digital rectal examination (DRE) with sphincter tone noted
  • investigations:
    • complete blood examination (CBE)
    • urea electrolytes and creatinine (UEC)
    • liver function test (LFT)
    • iron studies 
    • relevant previous imaging, endoscopy, colonoscopy, histology reports and pathology of specimens removed

Additional information to assist triage categorisation

  • chest-abdomen-pelvis computed tomography (CT)
  • faecal occult blood test (FOBT) results indicating whether this was complete through the National Bowel Cancer Screening Program

Clinical management advice

If concerns regarding diagnosis please discuss with Colorectal/General/Acute Surgical Unit surgical registrar dependent on Local Health Network.

Patients residing in the Central Adelaide Local Health Network catchment can be referred directly via the Routine Endoscopic Pathway electronic form CALHN Public Request Form if they require a routine endoscopy or colonoscopy. This new single service pathway that allows for better access to routine endoscopic procedures.

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.