Criteria for referral to public hospital service

• Progressive dysphagia

Information to be included in the referral

Information that must be provided

• History of dysphagia (onset, characteristics and duration of symptoms) and other symptoms over time
• Relevant medical history and comorbidities
• Any previous gastroscopy or other relevant investigations
• Current and complete medication history (including non-prescription medicines, herbs and supplements)
• Statement that the patient has indicated interest in having a gastroscopy
• Anaesthetic risk. Indicate if the patient has any of the following:
  • body mass index (BMI) > 40
  • a permanent pacemaker
  • any bleeding disorder
  • any cognition issues or impairment
  • any known or prior reaction to anaesthesia (malignant hyperthermia, suxamethonium apnoea, severe post-operative nausea or vomiting, known difficult airway)
  • any neuromuscular condition (e.g. myasthenia gravis, muscular dystrophy, cerebral palsy)
  • a respiratory disease that requires oxygen therapy or limits the patient’s daily activities (New York Heart Association (NYHA) Functional Classification class 3)
  • severe obstructive sleep apnoea
  • stage 4 or 5 chronic kidney disease (pre-dialysis or requires dialysis)
  • symptomatic ischaemic heart disease
  • valvular heart disease or congestive heart failure
• Anticoagulation or antiplatelet therapy. Indicate if the patient is taking any of the following medicines (or any other anticoagulant or antiplatelet therapy):
  • apixaban
  • aspirin
  • clopidogrel
  • dabigatran
  • low molecular weight heparin
  • prasugrel
  • rivaroxaban
  • ticagrelor
  • warfarin.

Provide if available

• Any relevant imaging, colonoscopy or gastroscopy results, including when and where previous endoscopy procedures were performed.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Direct access to gastroscopy requires a clinician to discuss the suitability of the procedure, provide information about the procedure and arrange pre-admission requirements with patients prior to them being placed on the procedure wait list. Where clinically appropriate the referral may be directed to a specialist clinic or service for assessment prior to the procedure.

Referrals for Dysphagia should be directed to gastroenterology service provided by the health service.

Referrals for oropharyngeal dysphagia should be directed to ENT service provided by the health service.

Referral to a public hospital is not appropriate for

Patients with oropharyngeal dysphagia or patients that do not have a history of oesophageal dysphagia.