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.

  • suspected acute and ongoing gastrointestinal bleeding associated with haemodynamic compromise or anaemia

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

Regional health networks 

Suitability for facilitated access procedures are determined by the clinical indication, sedation safety and general fitness, in alignment with the Australian Commission on Safety and Quality in Health Care Colonoscopy Clinical Care Standards.

Exclusions

  • patients who have had a good quality* colonoscopy < 4 years ago, without a specific indication
  • inappropriately performed faecal immunochemical test (FIT) positive individuals
  • patients who fall outside age criteria, ages 18 to 75
  • any patient requiring third party consent
  • patients who are high risk:
    • American Anaesthetic Association class IV
    • body mass index (BMI) > 45 kg/m2
    • any of the following medical comorbidities
      • pulmonary hypertension
      • cardiac failure under care of a cardiac failure specialist
      • untreated cardiac valvular disease
      • implantable cardiac defibrillator
      • lung disease under specialist care
      • renal failure on dialysis
      • liver cirrhosis – Child Pugh class B or class C
      • neurodegenerative/neurological disease with significant disability impacting cognition, swallowing and/or mobility

Triage categories

All patients with a positive FIT and no previous colonoscopy should be provided with a colonoscopy within 120 days of a positive screening test.

Category 1 (appointment clinically indicated within 30 days)

  • positive immunochemical faecal occult blood test (iFOBT)/faecal immunochemical test (FIT)/faecal human haemoglobin (FHH) - refer to Colorectal Cancer Screening - Adult CPC
  • screening positive FIT in a healthy individual aged 45 to 74 years of age
  • positive FIT in patients without a good quality* colonoscopy in the previous 4 years
  • new iron deficiency ≥ 45 years of age with no other obvious explanation
  • positive FIT in iron deficient otherwise healthy person < 45 years of age
  • rectal bleeding ≥ 45 years of age. If < 45 years of age please refer to Overt Rectal Bleeding CPC.
  • imaging highly suspicious for cancer, see referral information
  • Inflammatory Bowel Disease (IBD) referred from IBD Service/Specialist for assessment of disease activity

Category 2 (appointment clinically indicated within 90 days)

  • IBD referred from IBD Service/Specialist for surveillance
  • surveillance for:
    • previous polyps
    • polyp syndromes, e.g. serrated polyposis syndrome
    • colorectal cancer
    • family history groups
    • adherence to National Health and Medical Research Council (NHMRC) surveillance guidelines must be documented

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.

History

  • gastrointestinal symptoms
  • cardiorespiratory disease
  • sleep apnoea
  • renal impairment, details of any
  • diabetes type and treatments, see below
  • personal history of polyps or cancer, include details as possible with results
  • family history of cancer, including specific family members affected and ages
  • alcohol use
  • substance use
  • allergies

Examination

  • weight and height, essential
  • abnormal signs on general examination, e.g. pallor
  • abnormal signs on abdominal examination
  • details of rectal (PR) examination
  • details of proctoscopy/sigmoidoscopy, if done

Investigations

  • results of faecal immunochemical test (FIT), include date
  • iron studies and complete blood picture/exam
  • past colonoscopy and histopathology
  • relevant imaging

Medications

  • complete list of medications, in particular blood thinning medication and diabetes mellitus medications such as SGLT2 inhibitors, GLP1 agonists  — or these medications if used for other indications — and insulin.

Clinical management advice

Consider referral to a private provider after discussion with patient.

If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician or Gastroenterology Registrar on call to discuss your concerns.

Refer to relevant CPC for

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.