​​​​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:

  • Liver failure (bilirubin > 100, INR > 2.0) with clinical signs of decompensation
​

When public outpatient services are not routinely provided

  • Fatty liver with normal liver function tests and Fibrosis-4 (FIB 4) score below 1.3 (meaning no significant fibrosis evident)

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • Abnormal liver function tests if any of the following:
    • bilirubin > 34
    • albumin < 35
    • INR > 1.7 and/or platelets are outside normal range in setting of known or suspected liver disease (excluding unconjugated hyperbilirubinemia).
  • Abnormal liver function tests associated with new symptoms (e.g. nausea, anorexia) or ≥ 5% unexplained weight loss in past 1 month or ≥ 10% unexplained weight loss in past 6 months.
  • Persisting liver inflammation with ALT > 200 for more than a month.
  • New, abnormal liver function in a pregnant patient.
Category 2
Recommended to be seen within 90 calendar days.
  • Liver disease treatment required where outside the scope of the referrer scope of practice​.​
  • Metabolic syndrome or alcohol dependence suspected and non-invasive serological algorithm (Fibrosis-4 (FIB 4)) suggestive of cirrhosis (FIB 4 score above 3.5; a threshold where cirrhosis is likely), or elastography or radiologic evidence of cirrhosis.
Category 3
Recommended to be seen within 365 calendar days.
  • Metabolic syndrome associated liver function tests (LFTs) derangement suspected (MAFLD) and fibrosis indeterminate (FIB 4 score 1.3 – 3.5) where significant fibrosis and even cirrhosis is possible.
  • Abnormal LFTs and negative liver screen regardless of aetiology, severity or degree of work-up performed.
  • Fibrosis assessment requested (Fibro scan referral) when FIB 4 score above 1.3 (indeterminate), or known risk factors for chronic liver disease requiring monitoring (e.g. methotrexate, metabolic associated steatohepatitis, Hepatitis B).

Information to include within a referral

Required

  • Liver function test results (current and previous).
  • Full blood count or 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.
  • HbA1c.
  • Medication list, including over the counter and herbal medicines.
  • Alcohol intake (duration and quantity).
  • Risk factors for viral hepatitis.
  • Patient health summary (including relevant medical history and medications).

If available

  • Previous ultrasound, CT or MRI reports.
  • Elastography or other liver imaging.
  • Vaccination history.
  • Any relevant family history.
  • Additional pathology tests (e.g. autoimmune hepatitis, primary biliary cirrhosis, Wilson’s disease, genetic disorders).
  • 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.​​​

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