​​​​​​​​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • acute, severe abdominal pain for surgical review:
    • peritonitis, infarction or obstruction (for example, rigid abdomen, guarding, pain out of proportion to clinical signs)
    • suspected bowel obstruction – bilious vomiting, significant distention, lack of passage of flatus
    • suspected ectopic pregnancy, ovarian torsion, or testicular torsion
    • suspected appendicitis
    • acute inflammatory condition with systemic signs of sepsis requiring intravenous antibiotics, urosepsis, gynaecological sepsis, cholecystitis
    • abdominal pain associated with acutely irreducible hernia
  • shock or sepsis.

When public outpatient services are not routinely provided

  • Non-tertiary referrals for chronic abdominal pain without concerning features listed in the ‘Emergency’ and ‘Access and prioritisation’ criteria
  • Second opinions for conditions already seen by the same specialty.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Recurrent abdominal pain with any of the following concerning features:
    • faltering growth (weight loss > 2 weight centiles)
    • iron deficiency anaemia with Hb < 90
    • elevated inflammatory markers (raised platelet count, C-reactive protein, erythrocyte sedimentation rate and/or reduced albumin) if infection excluded (stool MCS or PCR negative)
    • tissue transglutaminase IgA (TTG IgA) > 10 x upper limit normal (ULN)
    • associated, persistent bloody diarrhoea > 2 weeks and infection excluded.
Category 2
Recommended to be seen within 90 calendar days.
  • Abdominal pain with iron deficiency anaemia.
  • Abdominal pain with associated persistent non-bloody and non-infectious diarrhoea for > 4 weeks.
  • Tertiary referrals for abdominal pain for > 8 weeks without concerning features: referral should be made from paediatrician or paediatric surgeon.

Information to include within a referral

Required

  • Reason for referral.
  • Details of the presenting condition including duration of symptoms and medical management to date.
  • Provisional diagnosis.
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • ‘Blue Book’, growth charts or any recent growth measurements
    • current weight and length or height
    • weight loss (amount and timeframe)
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
    • full blood count (FBC)
    • iron studies
    • liver function test results
    • coeliac serology: tissue transglutaminase IgA (TTG IgA), total IgA (where possible) with or without anti-endomysial antibody (EMA)
    • stool MCS, PCR and microscopy.

If available

  • Paediatrician report.
  • Previous investigations and reports of presenting abdominal pain (for example, endoscopy, radiological reports).
  • Faecal calprotectin result if inflammatory bowel disease suspected (in children aged > 4 years).
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ and/or among a vulnerable, disadvantaged or priority population.
  • If the patient is suitable for virtual care or telehealth.
  • If the patient has special needs or requires reasonable adjustments to be made.
  • If the patient requires an interpreter (if so, list preferred language).

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

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Current as at: Thursday 14 November 2024
Contact page owner: System Purchasing