Direct to an emergency department for:

  • Potentially life-threatening symptoms suggestive of acute severe lower gastrointestinal tract bleeding.

Criteria for referral to public hospital service

  • Positive immunochemical faecal occult blood test (iFOBT).

Information to be included in the referral

Information that must be provided

  • Faecal occult blood test results and if the test result was or was not detected through the National Bowel Cancer Screening Program (NBCSP)
  • Patient age
  • Onset, characteristics and duration of symptoms
  • Relevant medical history and comorbidities
  • Current and complete medication history (including non-prescription medicines, herbs and supplements)
  • Statement that the patient has indicated interest in having a colonoscopy
  • Statement that the patient understands the need for bowel preparation prior to colonoscopy
  • 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
  • Risk factors for poor bowel preparation for colonoscopy. Indicate if the patient has any of the following:
    • body mass index (BMI) > 30
    • chronic opioid use
    • constipation
    • type 1 diabetes
    • type 2 diabetes
    • Parkinson’s disease
    • previous bowel resection
    • stroke.

Provide if available

  • Previous and current gastrointestinal investigations and 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 colonoscopy requires a clinician to discuss the suitability of the procedure, provide information about the procedure and bowel preparation, and arrange the bowel preparation and other 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 Rectal bleeding should be directed to gastroenterology service provided by the health service.

Referrals for Persistent iron deficiency should be directed to gastroenterology service provided by the health service.

Referrals for severe haemorrhoids should be directed to colorectal service provided by the health service.

Note: FOBT is not indicated in asymptomatic people aged > 80 years

Referral to a public hospital is not appropriate for

Other statewide referral criteria should be used for patients that have symptoms but do not have a positive immunochemical faecal occult blood test (iFOBT).