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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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)

Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section. 

The following are not routinely provided in a public Gastroenterology service.

  • Screening colonoscopy in asymptomatic patients outside of the NHMRC guidelines

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