Shaping better health
REMEDY : BNSSG referral pathways

Urgent Gastroenterology Service - NBT

Checked: 18-07-2018 by Rob.Adams Next Review: 18-07-2019

Overview and Referral Criteria

NBT have a new service available via eRS to facilitate urgent outpatient appointments for patients with suspected or confirmed IBD. Once the patient has been referred, and if they fulfil the urgent criteria, they will be offered an appointment within 4 weeks. This service may also be appropriate for some patients who would otherwise be admitted to hospital. This service should not be used for patients with suspected cancer.

The criteria for this urgent service are:

Suspected IBD:

Symptoms of abdominal pain/discomfort, bloating, change in bowel habit (such as diarrhoea, with or without rectal bleeding) that have been present for at least 6 weeks

AND

A faecal calprotectin of > 200.

(If patient does not meet these criteria then please consider referral for direct access endoscopy for confirmation of diagnosis prior to a referral)

 

Confirmed IBD:  

Diagnosis made by endoscopy at an alternative treatment centre

AND

One or more of the following: 

  • 4 or more stools/day
  • Pyrexia
  • Heart rate > 90
  • Anaemia
  • Raised CRP (Dr Valliani at NBT suggest >20 indicates moderate flare and >45 indicates severe flare)

 

For patients who do not meet the criteria for the urgent service please refer via eReferral in the usual way (see Inflammatory Bowel Disease section)

Referral

To access the above service please submit via eReferral and request the NBT Urgent Gastroenterology Service.

This service is available via a RAS so that referrals will be triaged in secondary care and returned if criteria are not met.

Red Flags

Suspected Malignancy

Patients with suspected lower GI cancer please use the 2WW pathway (Direct to test, if appropriate, or 2WW eReferral).

Acute Severe Colitis

Patients with acute severe colitis may need more immediate treatment or admission so please discuss with on call gastroenterology team (IBD nurse or on call registrar/consultant).

Definition:

More than 6 bloody stools/day
AND
One or more of the following:
  • Pulse > 90
  • Temperature > 37.8
  • CRP > 45
  • Haemoglobin < 105 g/l