Altered bowel habit
+ 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.
- Potentially life threatening symptoms suggestive of:
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acute upper GI tract bleeding
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acute severe lower GI tract bleeding
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oesophageal foreign bodies/food bolus
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Acute Severe Colitis*
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bowel obstruction
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abdominal sepsis
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Severe vomiting and/or diarrhoea with dehydration
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Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
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Biliary sepsis (to be referred to a centre with ERCP service)
* 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)
+ Other management information
- Consider referring to a dietitian e.g. Fermentable oligo -, di-, mono-saccharides and polyols (FODMAP) diet
+ Minimum referral criteria - Does your patient meet the minimum referral criteria?
Does your patient meet the minimum referral criteria?
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Category 1 If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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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 To be included in all referrals
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
- A comprehensive capture of information in relation to MSH Referral Criteria
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 informationWithout this information the referral will be rejected
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+ Additional referral information for referrals
- Relevant imaging reports (e.g. pelvic USS)
- CA125
- Faecal calprotectin
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.
Last updated: Sunday, August 12, 2018
