Assessment for metabolic surgery suitability

ADULT

  • 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.

    • No emergency indicators identified; routine prioritisation applies
    • Referring clinician are encouraged to discuss with their patient the significant and irreversible lifestyle and behavioural changes that accompany bariatric surgery, prior to referral being made.
    • Patient eligibility is subject to inclusion and exclusion criteria, which includes:
    • Inclusion Criteria – patients must meet ALL criteria to be eligible for referral
      • Age between 18 to 65
      • BMI greater than or equal to 35kg/m2
      • Type 2 diabetes under treatment with two or more diabetes medications
      • HbA1C result of ≥ 6.5% as part of or following their diagnosis with type 2 diabetes
      • Meets eligibility threshold determined by referral form/GP Smart Referrals
    • Exclusion Criteria – patients that meet ANY of these criteria are not eligible for referral
      • Weight greater than 185kg
      • Patient has smoked cigarettes or other tobacco products (including e-cigarettes) in the past 6 months
      • Current alcohol or drug dependency
      • Previous bariatric surgery (including lap banding)
      • End stage complications of obesity including, but not limited to:
        • end stage cardiac disease with pulmonary hypertension
        • severe portal hypertension
        • cirrhosis
      • End-stage kidney disease (eGFR≤15 or patient on dialysis)
      • Any malignancy under active treatment (excluding non-metastatic skin cancer)
      • Any medical condition where surgery would significantly increase morbidity or mortality risk? (Including, but not limited to:
        • portal hypertension with varices
        • received/awaiting solid organ transplant
      • Unstable mental health condition (patient must be considered stable for at least 6 months prior to referral)
    • Patient will be required to watch a video outlining the Bariatric Surgery Pathway – a personalised link will be sent to them via SMS. Patients who do not watch the video may have their referral returned.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • No category 1 criteria
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • Assessment of patients for metabolic surgery suitability with
    • Type 2 diabetes;
    • BMI ≥ 35kg/m2;
    • under current treatment with two or more diabetes medications; and
  • Meets eligibility threshold determined by Bariatric Pathway Referral Form – Diabetes and/or GP Smart Referrals eligibility assessment

Please insert the below information and minimum referral criteria into referral

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

  • Confirmation of patient eligibility via either:
  • FBC
  • ELFT
  • Albumin/creatine ratio
  • HbA1C (result providing evidence of HbA1c≥6.5% and most recent result)
  • Lipid profile
  • Sleep study (if indicated as part of referral process)

3. Additional referral information Useful for processing the referral

  • Sleep study (if available)
  • Blood pressure
  • Iron studies, B12, folate, vit D (if available)
  • Ultrasound abdomen if abnormal liver function test
  • Echocardiogram

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.)

  • 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.

    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.

    • 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.

Last updated: 2 December 2024

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