Colorectal bowel disease

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

      Hernia

    • Suspected strangulated/incarcerated or obstruction of any hernia

      • Hepatobiliary/pancreatic surgery

    • New onset of obstructive jaundice
    • Acute cholecystitis
    • Gallstones with symptoms of cholangitis
    • Acute pancreatitis

      • Colorectal bowel disease

    • Bowel obstruction
    • Severe per rectum bleeding
    • Acute abscess at any site
    • Bowel perforation

      • Perineal disease and faecal incontinence

    • Acute painful perianal conditions with intractable pain
    • Perianal abscess

      • Other referrals to emergency

    • Acute, severe abdominal pain with or without associated sepsis
    • Acute painful perianal conditions

    • Refer to HealthPathways or local guidelines
    • Digital rectal examination (to exclude malignancy) should be performed for all patients with symptoms of colorectal cancer or other perianal pathologies
    • Lifestyle modification (e.g., increased physical activity, balanced healthy diet, weight reduction, smoking and alcohol cessation) can be very useful for a wide range of functional bowel and anorectal issues
    • Correction of iron deficiency and anaemia as soon as possible is paramount
    • Change in symptoms should initiate reassessment of previous results
    • GE screening guidelines (link when available)
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Diagnosed malignancies
  • Palpable or visible anorectal or abdominal mass
  • Recent significant unexplained weight loss c
  • GI obstructive symptoms or stricture
  • Colovesical or colovaginal fistula
  • FOBT positive Rectal bleeding with any concerning features (including those listed above):
    • Dark blood coating or mixed with stool
    • Iron deficiency
    • Tenesmus
Category 2
(appointment within 90 calendar days)
  • Chronic ongoing colorectal problems
  • Recurrent diarrhoea
  • Diverticular disease for evaluation
  • Rectal bleeding without concerning features  (see category 1)
  • Personal or family history of bowel cancer requiring screening or surveillance
  • Inflammatory bowel disease without complication
Category 3
(appointment within 365 calendar days)
  • Chronic constipation

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of presenting complaint (including any concerning features listed in Cat 1)
  • Co-morbid conditions and risk factors for colorectal disease
  • Family history of polyposis or inherited colorectal cancer syndromes, gastrointestinal malignancy or inflammatory bowel disease
  • Details and results/reports of most recent gastrointestinal investigations or procedures (e.g., imaging, colonoscopy, biopsy/polypectomy results) including letters of correspondence
  • Blood tests (e.g., FBC, E/LFT, U&E, CRP, Iron studies) if performed
  • CEA result (if colorectal cancer suspected

3. Additional referral information Useful for processing the referral

  • Digital anorectal examination findings
  • FOBT results

4. Request

  • Patient's 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

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that 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 becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • 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.

Last updated: 20 December 2021

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