Criteria for Referring Patients With Outpatient Gastroenterological Disease for Specialist Consultation: A Review of the Literature

Abstract

BackgroundDemands on gastroenterology are growing, as a result of the high prevalence of digestive diseases, the impact of colon cancer screening programs and an aging population. Prioritizing referrals to gastroenterology would assist in managing wait times. Our objectives were (1) to assess whether there were consistent criteria to guide referrals from family physicians for gastroenterological outpatient consultation and (2) to determine if there were different levels of urgency or priority in referral criteria.MethodsWe conducted a scoping review, searching Medline, Embase and Cochrane databases from 1997 to 2009, using the terms referral, triage, consultation and at least one from a list of gastroenterology-specific search terms. Of 2978 initial results, 51 papers were retrieved, and 20 were retained after review by two reviewers. Additional publications were identified through hand searches of retained papers, website searches and nomination by a panel of specialists.ResultsThirty-four papers, reports or websites were retained. No referral criteria covered the spectrum of disorders that might be referred by family physicians to gastroenterologists. Criteria for referral were most commonly listed for suspected colorectal cancer, followed by suspected upper GI cancer, hepatitis, and functional disorders.ConclusionsA clinical panel comprised of gastroenterologists and primary care providers, informed by this literature review, are completing the work of formulating a Gastroenterology Priority Referral Score, and plan to test the reliability and validity of the tool for determining the relative urgency for referral from primary care to gastroenterology.

Documentation and Management of CKD in Rural Primary Care

“…Although the appropriate timing of nephrology referral is unclear (29), late referral has been associated with a vast array of poor outcomes (3,(30)(31)(32)(33). Furthermore, early nephrology referral has been shown to slow the progression of CKD (34,35).…”

Can increased vigilance for chronic kidney disease in hospitalised patients decrease late referral and improve dialysis-free survival?

“…The underlying reasons why advanced CKD remains out of scope in so many patients are presumably multifactorial (1): several guidelines concerning when to refer to a nephrologist offer conflicting information [ 24 ] or are subject to national [ 25 , 26 ] or regional [ 27 ] related measures and agreements (2), these guidelines are often insufficiently known by clinical practioners [ 17 , 19 , 21 , 28 , 29 ] and (3) the evidence of the published guidelines is rather scarce.…”

Chapter 5: Referral to specialists and models of care

“…Although referral recommendations in the literature are inconsistent, criteria for nephrology referral include SCr or GFR, proteinuria, hematuria, BP, and electrolyte derangement. 670 Data relating to referral for those with glomerular disease, hypertension, AKI, and diabetes may be found in the relevant guidelines. 7,8,10, 262 …”