​​​​​​​​Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice via phone to on-call consultant/registrar:

  • Cirrhosis with acute clinical decompensation event (e.g. encephalopathy, gastrointestinal bleeding or new onset ascites, especially if with pain, fever or other systemic symptoms)
  • Liver failure (bilirubin > 100, INR > 2.0) with clinical signs of decompensation
  • Cholangitis (pain, fever and jaundice)
​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Suspected or known cirrhosis on imaging, non-invasive testing or pathology, and any of the following are present:
    • decompensation event (current or previous) (e.g. history of jaundice, ascites, confusion, gastrointestinal bleeding)
    • high risk features on laboratory (Child-Pugh score > B7, Model for End-stage Liver Disease (MELD) > 9, platelets < 150)
    • elevated alpha-fetoprotein (AFP) or space occupying lesion on imaging.
Category 2
Recommended to be seen within 90 calendar days.
  • Suspected or known cirrhosis on imaging, non-invasive testing or bloods, and any of the following are present:
    • underlying liver disease identified which cannot be treated in primary care (e.g. viral hepatitis – discretion of referring clinician, haemochromatosis, autoimmune liver disease, primary sclerosing cholangitis)
    • new diagnosis of cirrhosis with no prior specialist assessment or management plan.
Category 3
Recommended to be seen within 365 calendar days.

Routine care for known cirrhosis which requires assessment within 6 months (e.g. hepatocellular cancer surveillance, oesophageal varices screening, nutrition (patients with stable compensated who only require hepatocellular cancer surveillance may be appropriately managed in general practice).

Information to include within a referral

Required

  • Alcohol intake.
  • Risk factors for viral hepatitis.
  • Medication list, including over the counter and herbal medicines.
  • Current and previous liver function tests.
  • Full blood count/coagulation profile.
  • Upper abdomen ultrasound.
  • Hepatitis A serology (HAV IgG).
  • Hepatitis B serology (HBV sAg, sAb, cAb, and if HbsAg+, HBeAg/Ab and HBV DNA).
  • Hepatitis C serology (HCV Ab and if Ab+, HCV RNA).
  • ​Iron studies.
  • Patient health summary (including relevant medical history and medications).

If available

  • HbA1c.
  • ANA, immunoglobins.
  • Previous ultrasound, CT or MRI reports.
  • Previous endoscopy reports.
  • Vaccination history.
  • Any relevant family history.
  • If the patient identifies as Aboriginal and/or Torres Strait Islander.
  • If the patient is considered ‘at risk’ and/or among a vulnerable, disadvantaged or priority population.

Important information for referring health professionals​

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.​​​

​Contact us

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Current as at: Wednesday 14 February 2024
Contact page owner: System Purchasing