Colonoscopy

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.

Upper GI endoscopy

  • Potentially life-threatening symptoms suggestive of:
    • acute upper GI tract bleeding (bright red blood, PR bleeding, melena, hematemesis)
    • acute severe lower GI tract bleeding
  • Oesophageal foreign bodies/food bolus
  • Displaced gastrostomy tube 

Colonoscopy

  • Potentially life-threatening symptoms suggestive of:
    • acute severe colitis*
    • bowel obstruction
    • abdominal sepsis
  • Severe vomiting and/or diarrhoea with dehydration

*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 >20mg/dl at presentation (or ESR > 30 mm/hr)
Useful Management Information
  • No additional information
Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar 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

Presence of following 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

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)

Category 2
(appointment within 90 calendar 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

Absence of the following 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 3
(appointment within 365 calendar days)
  • Family history of colorectal cancer with either:

    • One first degree relative diagnosed with CRC <55yrs old
    • Two first degree 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.

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If you still need to refer your patient:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

 

Standard Referral Information

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • 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 functioning – low/medium/high
  • 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

Essential referral information

Without this information the referral will be returned

  • 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 Referral Information
  • Recent relevant imaging (USS, CT, MRI)
  • iFOBT 
  • Faecal calprotectin
Clinical Override

Clinical override of referral criteria may be requested in the following situations:

  • Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
  • Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
  • Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.

Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.

Out of catchment

West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.

Feedback

To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.