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 bowel obstruction – vomiting, significant distention, inability to pass flatus, obstipation
- acute surgical pathology e.g. evidence of peritonism, tender ileal mass, systemic toxicity
- acute severe ulcerative colitis (ASUC) ≥ 6 bloody bowel stools per 24 hours (Truelove and Witts criteria) as well as any of the following:
- temperature > 37.8°C
- pulse rate > 90 bpm
- haemoglobin (Hb) < 105 g/l
- C-reactive protein (CRP) > 30mg/L at presentation or erythrocyte sedimentation rate (ESR) > 30 mm
For 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
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
Category 1 — appointment clinically indicated within 30 days
Known or suspected inflammatory bowel disease (IBD) with any of the following red flags:
- rectal bleeding
- significant or new anaemia
- symptoms/signs of systemic illness + raised inflammatory markers
- suspected bowel obstruction via the emergency department (ED)
- fever and/or abdominal / perineal mass
- significant bloody stools / diarrhoea ≥ 6 per day if acute severe ulcerative colitis (ASUC) via the ED
- weight loss ≥ 5% of body weight in previous 6 months
Category 2 — appointment clinically indicated within 90 days
- symptomatic known or suspected IBD without red flags
Category 3 — appointment clinically indicated within 365 days
- monitoring and/or surveillance activities including surveillance colonoscopy
For information on referral forms and how to import them, please view general referral information.
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.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- time course, pattern and duration of symptoms
- any extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) features including:
- eye disease (iritis, episcleritis)
- skin lesions (pyoderma, erythema nodosum)
- mouth ulceration
- joint pain
- perianal disease, yes/no description if present
- diet, nutrition
- mental health, psychosocial situation, employment, sick leave
- medication adherence if known IBD
- current and previous IBD therapy with response/toxicities/dates
- abdominal mass (yes/no) especially in right iliac fossa
- perianal and digital rectal exam
- check for EIMs of IBD
- nutrition assessment – weight loss, sarcopenia
- signs of systemic toxicity – fever, tachycardia, peritonism
- complete blood examination (CBE)
- C-reactive protein (CRP)
- urea, electrolytes, and creatinine (UEC)
- liver function tests (LFT)
- faecal calprotectin
- iron studies if haemoglobin (Hb) or mean corpuscular volume (MCV) are low
- vitamin B12, folate, vitamin D – if signs of weight loss, malnutrition
- stool microscopy, culture and sensitivity (MCS) and polymerase chain reaction (PCR) including Clostridium difficile (acute episode)
- relevant imaging reports (computed tomography, magnetic resonance enterography, ultrasound, previous endo/colonoscopy)
Clinical management advice
Inflammatory bowel disease (IBD) usually requires specialist gastrointestinal coordination utilising a shared care model with General Practitioners.
Patients with known IBD should be reviewed by a specialist annually, or more frequently if requiring immunosuppression or biological therapies.
Attention to screening and surveillance activities along with maintenance of remission generally results in normal quality of life.
General Practitioners are an important part of ongoing patient management to ensure vaccinations are up to date, smoking cessation is encouraged, and cancer prevention activities adhered to.
Category 3 referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but the referral is declined, you are encouraged to contact the triaging clinician to discuss your concerns.
If a patient has been fully investigated within last 2 years and symptoms remain unchanged, clinician discretion is needed to appropriately refer and triage. In general, there is little value in repeat specialist assessment and/or endoscopic procedures in this scenario.
- HealthPathways SA - Inflammatory Bowel Disease (IBD) (log in required)
- Gastroenterology Society of Australia - Clinical Practice Resources
- Department of Health and Aged Care - National Strategic Action Plan for IBD 2019
- SA Health - Quitting Smoking
- Royal Australian College of General Practitioners - Smoking Cessation
- Cancer Council of Australia