Assessment for metabolic surgery suitability

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

No category 1 criteria

Category 2

Appointment within 90 days is desirable

No category 2 criteria

Category 3

Appointment within 365 days is desirable

Assessment of patients for metabolic surgery suitability with
Type 2 diabetes;
BMI ≥ 35kg/m2;
under current treatment with two or more diabetes medications; and

Meets eligibility threshold determined by Bariatric Pathway Referral Form – Diabetes and/or GP Smart Referrals eligibility assessment

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

Referring clinician are encouraged to discuss with their patient the significant and irreversible lifestyle and behavioural changes that accompany bariatric surgery, prior to referral being made.
Patient eligibility is subject to inclusion and exclusion criteria, which includes:

Inclusion Criteria – patients must meet ALL criteria to be eligible for referral

Age between 18 to 65
BMI greater than or equal to 35kg/m2
Type 2 diabetes under treatment with two or more diabetes medications
HbA1C result of ≥ 6.5% as part of or following their diagnosis with type 2 diabetes
Meets eligibility threshold determined by referral form/GP Smart Referrals

Exclusion Criteria – patients that meet ANY of these criteria are not eligible for referral

Weight greater than 185kg
Patient has smoked cigarettes or other tobacco products (including e-cigarettes) in the past 6 months
Current alcohol or drug dependency
Previous bariatric surgery (including lap banding)
End stage complications of obesity including, but not limited to:
- end stage cardiac disease with pulmonary hypertension
- severe portal hypertension
- cirrhosis
End-stage kidney disease (eGFR≤15 or patient on dialysis)
Any malignancy under active treatment (excluding non-metastatic skin cancer)
Any medical condition where surgery would significantly increase morbidity or mortality risk? (Including, but not limited to:
- portal hypertension with varices
- received/awaiting solid organ transplant
Unstable mental health condition (patient must be considered stable for at least 6 months prior to referral)

Patient will be required to watch a video outlining the Bariatric Surgery Pathway – a personalised link will be sent to them via SMS. Patients who do not watch the video may have their referral returned.

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

Confirmation of patient eligibility via either:
- Completed Bariatric Pathway Referral Form – Diabetes indicating patient eligible for referral; and/or
- GP Smart Referrals eligibility assessment indicating patient eligible for referral.
FBC
ELFT
Albumin/creatine ratio
HbA1C (result providing evidence of HbA1c≥6.5% and most recent result)
Lipid profile

Sleep study (if indicated as part of referral process)

Additional Referral Information (useful for processing the referral)

Sleep study (if available)
Blood pressure
Iron studies, B12, folate, vit D (if available)
Ultrasound abdomen if abnormal liver function test
Echocardiogram

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