Perineal disease and faecal incontinence

Emergency referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Persistent perineal sepsis

Category 2

Appointment within 90 days is desirable

Symptomatic obstetric anal sphincter injury (OASIS)
Fissure not responding to maximal medical treatment after 6 weeks
External rectal prolapse

Category 3

Appointment within 365 days is desirable

Pilonidal disease
Warts
Uncomplicated haemorrhoids
Anal skin tags and benign peri-anal polyps
Uncomplicated fistula in ano
Faecal incontinence

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

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

Other important information for referring practitioners

Not an exhaustive list

Local application of cold packs and oral anti-inflammatory medications
Referral to pelvic floor physiotherapist
Education about pelvic floor care and specific techniques for defecation
Oral antibiotics such as Augmentin®, or clindamycin where penicillin allergy is a factor, should be considered.
Sexual counselling for the couple
Counselling for subsequent pregnancy management
Importance of follow-up six weeks and three months postpartum
Postpartum management: avoid constipation, use of aperients, dietary advice
Reassurance and provide support – psychological

Fistula
Persisting fistula discharge/infections Glyceryl trinitrate 0.2% ointment
(Rectogesic®): TDS for four-six weeks (NS)
Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)

Pilonidal Sinus
Amoxicillin and clavulanic acid is the preferred antibiotic.
Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
Advice on hygiene, sweating activity, activity associated with sitting and buttock friction

Referral requirements

A referral may be rejected without the following information.

Essential referral information

General referral information
Previous gastroenterologist investigations and results (date, report and histology results) e.g. last 2-3 clinic letters
Management to date including timeline, medication and lifestyle
History of previous drainage operation

Additional referral information useful for processing the referral

OASIS

Assess sphincter function and integrity and endoanal USS results

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

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

Clinical Information (essential)

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
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
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient’s Demographic Details (essential)

Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Other Information (where relevant)

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.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au