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Colonoscopy

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

  • Potentially life-threatening symptoms suggestive of:
    • acute severe colitis

      Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

      • temperature at presentation of > 37.8°C,
      • pulse rate at presentation of > 90 bpm,
      • haemoglobin at presentation of < 105 gm/l, CRP > 20 mg/dl at presentation (or ESR > 30 mm/hr)
    • bowel obstruction
    • abdominal sepsis
  • Severe vomiting and/or diarrhoea with dehydration

Minimum referral criteria

All requests are categorised using state‑wide urgency criteria.

Category 1 - Seen within 30 days

  • Mass palpable on abdominal or rectal examination
  • Positive faecal occult blood test (iFOBT) asymptomatic
  • Severe abdominal pain with presence of concerning features or significant impact on activities of daily living
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and /or presence of concerning features
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and with presence of concerning features
  • Rectal bleeding with presence of concerning features
  • Unexplained weight loss and presence of concerning features
  • Abnormal radiology
    NB for patients with symptoms suggestive of colorectal cancer, the total time from first healthcare presentation to diagnostic colonoscopy should be no more than 120 days. Diagnostic intervals greater than 120 days are associated with poorer clinical outcomes. First healthcare presentation is defined as the date of presentation in general practice with symptoms suggestive of colorectal cancer or positive iFOBT for screening. (Cancer Council Australia, 2017)

    Concerning features:

    • Dark blood coating or mixed with stool
    • Bloody or nocturnal diarrhoea
    • Weight loss, ≥ 5% of body weight in previous 6 months
    • Abdominal / rectal mass on clinical examination or abnormal imaging
    • Persistent abdominal pain
    • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
    • Patient and family history of bowel cancer (1st degree relative < 55 years old)
    • iFOBT or calprotectin +ve

Category 2 - Seen within 90 days

  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and in the absence of concerning features
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and in the absence of concerning features
  • Rectal bleeding in the absence of concerning features
  • Unexplained weight loss in the absence of concerning features

Category 3 - Seen within 365 days

  • one first-degree relative diagnosed with CRC < 55 years
  • two first-relatives diagnosed with CRC at any age
  • one first degree plus at least two second degree relatives with CRC at any age

NB: these relatives with CRC can be taken from both sides of the family i.e., they do not have to be all on the same side.

Information for colonoscopy referrals

Include the standard information and condition-specific information.

Standard information for all referrals

Reason for request

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

Patient's demographic details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Phone contact numbers – 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 Torres Strait Islander Ask the patient their ethnicity

Referring practitioner details

  • Full name
  • Full address
  • Contact details – phone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Patient's usual general practitioner (if different from above)

Relevant clinical information about the condition

  • Inclusion of Clinical Prioritisation Criteria (CPC) where relevant
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Investigations carried out and results as indicated in the relevant pathway
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Options already pursued
  • 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

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 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, WorkCover, motor vehicle insurance)

Essential information for colonoscopy referrals

  • Family or personal history of colorectal cancer and any genetic diagnosis
  • Symptom profile
  • Previous endoscopic procedures (date, report and histology)
  • Rectal examination (not required for surveillance referrals and patients with symptoms)
  • ELFT, FBC, iron studies results

Additional information for colonoscopy referrals

  • Recent relevant imaging (USS, CT, MRI)
  • iFOBT
  • Faecal calprotectin

Anticoagulants

There is no need to stop any anticoagulant before an endoscopy procedure. The endoscopist will decide to intervene or recall the patient, if something is found during the procedure.

Forms

Complete the Endoscopy Referral Form (Rockhampton "Straight to test" requests only)  and send via secure messaging. If unable to attach investigations or use secure messaging, see alternative contact details.

Print the Adult Integrated Pre‑screening Tool for the patient to complete and either:

  • bring to the appointment.
  • fax it with referral form.

Information for your patient

Expected time frame for appointment notifications

  • Once the request is received, categorisation by the hospital will occur.
  • General practitioners and patients are notified of the assigned category between 14 days to 1 month after completed request is received.
  • Patients are usually notified of the upcoming appointment time and date approximately 4 weeks prior unless short notice appointments become available.

Appointment information

  • Patients will be given an appointment via phone, SMS, or letter.
  • The patient must contact the hospital to reschedule if they are not able to attend.
  • If the patient fails to respond to 2 appointment offers:
    • They will be discharged back to their general practitioner.
    • They can have a new request for assessment sent to the hospital if the need still exists.
  • The patient's first appointment may not always be with a specialist. Where appropriate, the request may be sent to a public allied health or nursing service for initial assessment and management. A specialist assessment may then be arranged or ruled out.

Ask your patient to:

  • take a list of current medications, and all relevant radiology films and reports to appointments.
  • advise of any change in circumstance (e.g., getting worse or becoming pregnant), as this may affect the request for assessment.
  • update their contact details (e.g., phone number and address) with the hospital.
Last updated: 24 January 2020

Named referrals

If you would like to send a named referral, please address it to a specialist listed below.

Rockhampton

  • Dr Garry Dyke
  • Dr Katarzyna Zalewska
  • Dr Chitrakanti Kapadia
  • Dr Yiu Ming Ho
  • Dr Maseelan Naidoo

Gladstone

  • Dr Maseelan Naidoo

> view all CQ Health specialists

Send referral

Specialist Outpatient Department

Fax: 1300 017 155

CQ Fracture/urgent referrals
Fax: (07) 4920 7242

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