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Dyspepsia/heartburn/reflux

ADULT

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:
    • acute upper GI tract bleeding

    • acute severe lower GI tract bleeding

    • oesophageal foreign bodies/food bolus

    • Acute Severe Colitis*

    • bowel obstruction

    • abdominal sepsis

  • Severe vomiting and/or diarrhoea with dehydration

  • Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services

  • 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 >30mg/dl at presentation (or ESR > 30 mm/hr)

  • Refer to Healthpathways or local guidelines

Consider the following:

  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
  • Treatment if H pylori present
  • Cease any aggravating medications if possible e.g. NSAIDS, aspirin
  • Antacid therapies
  • Other evidence based therapies (e.g. prokinetics)

NB: If a patient who has been fully investigated 2 years prior to referral.  Then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and or value in repeat endoscopy / colonoscopy procedures

 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)

    • Any patient with significant impact on activities of daily living, unexplained, persistent, or recent-onset symptoms (treatment-resistant) with any of the following concerning features:
      • gastrointestinal bleeding
      • weight loss, ≥5% of body weight in previous 6 months
      • difficulty swallowing
      • persistent vomiting
      • iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women

     

     

     

  • Category 2
    (appointment within 90 calendar days)

    • Any patient with significant, unexplained, persistent, or recent-onset symptoms (treatment-resistant) without concerning features

  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

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

  • Family history of gastrointestinal cancers
  • Medical management to date (document treatments offered and efficacy including failed treatment with moderate dose PPI for dyspepsia)
  • FBC, iron studies results

3. Additional referral information Useful for processing the referral

  • Previous endoscopic procedures (date and report)
  • Relevant imaging reports
  • H pylori 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.)
  • 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.