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, severe abdominal pain for surgical review:
    • peritonitis, infarction or obstruction – for example, rigid abdomen, guarding, pain out of proportion to clinical signs)
    • suspected bowel obstruction – bilious vomiting, significant distention, lack of passage of flatus
    • suspected ectopic pregnancy, ovarian torsion, or testicular torsion
    • suspected appendicitis
    • abdominal pain associated with acutely irreducible hernia
  • shock or sepsis

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-tertiary referrals for chronic/recurrent abdominal pain without concerning features listed in the ‘Emergency’ and ‘Triage categories’ criteria, refer instead to Abdominal Pain - Paediatric Medicine CPC

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • recurrent abdominal pain with any of the following concerning features:
    • faltering growth, weight loss > 2 weight percentiles
    • iron deficiency anaemia with haemoglobin (Hb) < 85g/L
    • significant abnormality in inflammatory markers – raised platelet count, C-reactive protein (CRP), erythrocyte sedimentation rate and/or reduced albumin; and infection excluded – stool microculture and sensitivities (MCS) or faecal multiplex polymerase chain reaction (PCR) negative
    • tissue transglutaminase immunoglobulin IgA (TTG IgA) > 10 x upper limit normal (ULN)
    • associated, persistent bloody diarrhoea > 2 weeks and infection excluded

Category 2 (appointment clinically indicated within 90 days)

  • abdominal pain with iron deficiency anaemia – see also ‘Iron Deficiency Anaemia CPC’
  • abdominal pain with associated persistent non-bloody and non-infectious diarrhoea for > 4 weeks
  • tertiary referrals for abdominal pain for > 8 weeks without concerning features: referral should be made from paediatrician or paediatric surgeon

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.

  • details of presenting condition including onset and duration of symptoms
    • onset and duration of symptoms
    • frequency and severity of symptoms
    • current management regime
  • 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:
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • full blood count (FBC)
    • iron (Fe) studies
    • liver function test (LFT) results
    • coeliac serology: tissue transglutaminase immunoglobulin A (TTG IgA), total IgA (where possible) with or without anti-endomysial antibody (EMA)
    • stool microculture and sensitivities (MCS)
    • faecal multiplex polymerase chain reaction (PCR) and microscopy

Additional information to assist triage categorisation

  • paediatrician report, if available
  • previous investigations and reports of presenting abdominal pain, e.g. endoscopy, radiological reports
  • faecal calprotectin result if inflammatory bowel disease suspected, in children aged > 4 years

Clinical management advice

In many cases, more serious causes of abdominal pain can be reasonably excluded by a thorough history and examination, without the need for extensive investigation.

Refer also to relevant CPCs for:

  • Altered Bowel Habit
  • Coeliac Disease
  • Inflammatory Bowel Disease
  • Iron Deficiency Anaemia with Suspected Gastrointestinal Cause

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.