Chronic diarrhoea and/or persistent vomiting

PAEDIATRIC

  • 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.

    • Vomiting or diarrhoea with weight loss in an infant <1 year
    • Suspected pyloric stenosis
    • Bile-stained vomiting
    • Acute onset abdominal distention
    • Weight loss with cardiovascular instability, e.g. postural heart rate changes
    • New onset of blood in diarrhoea or vomitus
    • Refer to local HealthPathways or local guidelines
    • Chronic diarrhoea is diarrhoea present for more than 3 weeks
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Infants under 1 year
  • Significant weight loss at any age/failure to gain weight
  • Vomiting during sleep
  • Bloody diarrhoea
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age), or
    • Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)
    where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2
(appointment within 90 calendar days)
  • Most other referrals with chronic diarrhoea and/or vomiting
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

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

  • Current height and weight and include date of measurement
  • History of diarrhoea – duration, frequency
  • Report presence or absence of concerning features for chronic diarrhoea
    • Blood or mucus
    • Nocturnal waking to stool
    • Urgency and incontinence
    • Weight loss
  • Does the child have abdominal pain? If so report presence or absence of concerning features for abdominal pain
    • Recurrent waking from sleep with pain
    • Non midline pain
    • Weight loss
    • Fevers
    • Blood or mucus mixed in stool
    • Waking at night to stool
  • Stool PCR for bacteria and  parasites (if chronic diarrhoea present)/calprotectin
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category.

  • If abdominal pain is present, history including frequency, duration and level of disruption (school missed, Emergency presentations, other history of distress).
  • History of vomiting – duration, frequency, hematemesis
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Details of treatments offered and efficacy

Desirable information- will assist at consultation

  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Safety, Seniors and Disability Services involvement)
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Perianal inspection/fissures fistulae
  • Any relevant laboratory results or medical imaging reports, urinalysis result

Investigations to consider if indicated (use clinical judgement)

  • FBC with differential. ESR U&E LFTs
  • Coeliac screen (aTTG) and total IgA level
  • Faecal calprotectin

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.

    • 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: 4 December 2024

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