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
  • severe/uncontrolled 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 on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Most local health networks have dedicated inflammatory bowel disease (IBD) services. If a patient is known to one of these services, please contact the relevant IBD service prior to outpatient referral.

For more urgent clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Crohn’s and Colitis Australia

Category 1 (appointment clinically indicated within 30 days)

  • persistent perineal sepsis
  • significant new change in bowel habit
  • suspected stricture
  • severe symptoms unresponsive to medical management

Category 2 (appointment clinically indicated within 90 days)

  • anal fistula with known Crohn’s disease
  • post resection follow up for inflammatory bowel disease

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/surgical history
  • family history
  • medications and allergies
  • smoking/alcohol and other drug status
  • presenting symptoms
    • abdominal pain/distention
    • details of stool frequency
    • nausea and vomiting
    • pain, swelling, and redness of the overlying skin if concerns of fistula or abscess
    • presence of discharge
    • signs of recent weight loss
    • previous management trialled and outcomes
    • social and emotional impact for example, acts of daily living/employment
  • height/weight
  • body mass index (BMI)
  • examination findings
    • abdominal examination
    • perineal and digital rectal examination (DRE) noting sphincter tone
  • pathology:
    • complete blood examination (CBE)
    • electrolytes urea and creatinine (EUC)
    • liver function test (LFT)
    • c-reactive protein (CRP)
  • reports of prior colonoscopies and any pathology of specimens removed
  • relevant diagnostic/imaging reports, including location of company and accession number

Additional information to assist triage categorisation

  • pathology
    • serum calprotectin, if performed
  • computed tomography (CT) fistulogram – sinogram (suspected fistula) – should not delay referral

Clinical management advice

Inflammatory bowel disease (IBD) related complications are best managed through a multi-disciplinary team service to provide the best outcome.

For chronic disease management we would recommend accessing the IBD nurses affiliated with the metropolitan local health networks.

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.