Polyp surveillance
Adult

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Emergency Referrals

Useful Management Information

NHMRC Clinical Practice Guidelines (2017) recommended screening colonoscopy schedules for polyp surveillance (GESA Gastroenterological Society of Australia, 2009)

5 yearly – If < 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) provided that all polyps are ‘simple’ as defined by dimensions (<10mm) and histopathology (no high-grade dysplasia or villous change)
3 yearly – If > 3 polyps (excluding diminutive rectosigmoid hyperplastic polyps) or if one or more polyps are ‘advanced’ as characterised by dimensions (≥10mm) and/or histopathology (presence of high-grade dysplasia or villous change)
Annual – If 5 to 9 polyps (excluding diminutive rectosigmoid hyperplastic polyps)
<12 months – If required, a baseline colonoscopy may need to be repeated in cases of poor bowel preparation (immediate rescheduling), possible incomplete excision of a large polyp (often at 3 months) or the presence of multiple adenomas (≥10) to ensure complete clearance

NB: patients with Familial Adenomatous Polyposis (FAP) and Lynch syndrome (HNPCC) need punctual surveillance due to the high-risk nature of these conditions.

NB: If a patient has been fully investigated 2 years prior to referral, then the referrer and the receiving clinician will need to exercise clinical decision making in triaging and/or value in repeat endoscopy/colonoscopy procedures

Clinical resources

NHMRC Clinical Practice Guidelines (2017)
Cancer Council Australia  (2018)

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	See Useful Management Information section for guideline information
Category 2 (appointment within 90 calendar days)	See Useful Management Information section for guideline information
Category 3 (appointment within 365 calendar days)	See Useful Management Information section for guideline information
Consider other treatment pathways or an alternative diagnosis If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Relatives diagnosed with Familial Adenomatous Polyposis (FAP) (if applicable)
Relatives diagnosed with Lynch Syndrome (HNPCC) (if applicable)
Family or personal history of colorectal cancer
Previous endoscopic procedures (date, report and histology)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

No additional referral information

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Not available

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Sneha John

Medical Director Endoscopy

Facilities

Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Polyp surveillanceAdult