​​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:

  • Melaena or haematochezia, haematemesis or vomiting in large volume or with haemodynamic compromise

When public outpatient services are not routinely provided

  • Completed colonoscopy with adequate bowel preparation in the last 2 years for the same symptoms
    Note: Colonoscopy is not required if already performed in the last 2 years and findings were normal (i.e. no polyps) so long as there are no new symptoms or other indication for more frequent colonoscopy​.
  • Haemorrhoid surgery or banding (if medical therapy fails)
    Note: referral to colorectal surgery is indicated​​
  • Fissure surgery (if medical therapy fails)
    Note: referral to colorectal surgery is indicated
  • Persistent but unchanged gastrointestinal symptoms previously investigated
​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Positive Immunochemical Faecal Occult Blood Test (iFOBT), including those screened through a bowel screening program.
  • Aged ≥ 40 years and positive FOBT with any of the following symptoms:
    • rectal bleeding
    • change in bowel habit or any lower gastrointestinal symptoms
    • unexplained anaemia (Hb < Lower Limit of Normal).
  • Aged ≥ 50 years and negative FOBT, but any of the following symptoms:
    • rectal bleeding
    • change in bowel habit or any lower gastrointestinal symptoms
    • unexplained anaemia (Hb < Lower Limit of Normal).
  • Any age and ≥ 5% unexplained weight loss in past 1 month or ≥ 10% unexplained weight loss in past 6 months.
  • Any age and abnormal imaging concerning for colorectal or upper gastrointestinal cancer.
Category 2
Recommended to be seen within 90 calendar days.
  • Aged < 39 years and positive FOBT with any of the following symptoms:
    • rectal bleeding
    • change in bowel habit or any lower gastrointestinal symptoms
    • unexplained anaemia (Hb < Lower Limit of Normal).
  • Aged 40 to 49 years and negative FOBT, but any of the following symptoms:
    • rectal bleeding
    • change in bowel habit or any lower gastrointestinal symptoms
    • unexplained anaemia (Hb < Lower Limit of Normal)
  • Age < 49 years old and change in bowel habit with elevated faecal calprotectin (> 100 micrograms/g).
Category 3
Recommended to be seen within 365 calendar days.
  • Age < 39 years old, negative FOBT with any of the following symptoms:
    • rectal bleeding
    • change in bowel habit or any lower gastrointestinal symptoms
    • unexplained anaemia (Hb < Lower Limit of Normal).
  • Family history of colon cancer and:
    • known or suspected hereditary colon cancer syndrome (age for colonoscopy depends on syndrome)
    • suggestive of a moderate or high-risk colon cancer (see Cancer Council Guidelines for more information).
  • Personal history of polyps or colon cancer and recommended for repeat colonoscopy (provide Charleston comorbidity index score for age > 75).

Information to include within a referral

Required

  • Patient and family history of gastrointestinal cancer, including age of diagnosis.
  • Documented duration and associated symptoms.
  • Weight loss (amount and timeframe).
  • Full blood count.
  • Haematinics (iron studies, red blood cell count, folate and vitamin B12).
  • Patient health summary (including relevant medical history and medications).

If available

  • Faecal Occult Blood Test (FOBT) result.
  • Electrolytes, urea and creatinine (EUC).
  • Rectal examination result.
  • Relevant imaging results.
  • Current and previous colonoscopy results (including histology).
  • 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

If you would like to provide feedback about the contents of this page, please submit an enquiry to the SRC project team at NSW Health.

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