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Specialist Nutrition

Emergency department referrals

All urgent cases must be discussed with the on call Gastroenterology 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
  • Caboolture Hospital (07) 5433 8888

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.

If any of the following are present or suspected in patients, arrange immediate transfer to the emergency department:

  • Potentially life-threatening symptoms suggestive of:
    • Line Sepsis in patients on Home Parenteral Nutrition (HPN)
    • Post Gastrostomy insertion or replacement - complications for e.g., pain on administration of fluid/feed, peritonitis, bleeding, site abscess etc.
    • Severe vomiting and/or diarrhoea with dehydration
    • Bowel obstruction
  • Blocked intravenous line in patients on HPN
  • Displaced Enteral feeding tubes (if unable to contact SNST or out-of-hours).  Gastrostomy or Jejunostomy fistula may close within 4 hours.

This is not an exhaustive list and patients may have other Medical Emergencies.

Referrals to the Specialist Nutrition Support Team (SNST):

The SNST is based at RBWH and offers a multi-discipline and specialized nutrition service to Queensland patients.  The team comprises of a Gastroenterology Consultant, Enteral Nutrition Dietitian, Home Parenteral Nutrition Dietitian, a Pharmacist, a Clinical Nurse Consultant, and an AO. The service provides specialist care to patients with complex acute and chronic diseases requiring nutrition support, and advice to clinicians involved in these patients’ healthcare management.

Patients who may be referred to SNST outpatients include:

  • those who are severely malnourished (weight loss ≥10%), and are needing advice from the SNST for consideration of artificial nutrition support (ANS), or
  • those who are on ANS – Enteral (EN) &/or Parenteral Nutrition (PN), or
  • those who have received advice from SNST in the past

Excluded Referrals:

  • Patients with an Eating Disorder – Suspected or confirmed eating disorders should be managed in accordance with the Queensland Eating Disorder Service A guide to admission and inpatient treatment for people with eating disorders in Queensland
  • Patients with symptoms relating to Functional bowel disorder, Intestinal dysmotility or Gastroparesis should be referred to Neurogastroenterology Multidisciplinary (NMC) GE clinic (unless already receiving ANS or reviewed by SNST in the past).
  • Problems with Surgical Jejunostomy within 3 months of insertion – refer to surgeons
  • Malnutrition or micronutrient deficiency post-Bariatric surgery – please refer back to the treating team.

 

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

  • Patient with unintentional weight loss of ≥10%, being considered for ANS and before receiving either EN or PN (see excluded referrals)
  • Patient receiving ANS and with unintentional weight loss of ≥5%
  • Patient receiving ANS needing escalation of nutrition support,g. persisting nutritional deficiencies, needing PN etc.
  • Complications of Enteral Feeding devices such as, persistent leakage, device degradation or puncture, site pain, recurrent site cellulitis etc. (if any of these are severe, please refer as Emergency).

 

Category 2

Appointment within 90 days is desirable

  • Patient with unintentional weight loss of ≥5 and <10%, being considered for ANS and before receiving either EN or PN (see excluded referrals)
  • Long term management of Enteral feeding devices

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

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

  • Some of these patients have complex needs and, on occasions, we may need your involvement in a multi-disciplinary case conference (MDCC)

 

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • General referral information including weight history
  • Confirm patients are fully investigated for their weight loss, include cause if known [Assessment guidelines for unintentional weight loss are on Health Pathways / Refer your patient under general medicine]. Unintentional weight loss – Metro North Health
  • Dietetic appointment outcome, including current and previous ANS regimen/s
  • FBC, ELFTs, Mg, Lipids, TSH, Vitamin B12, Folate, Iron studies, Vitamin D, CRP.
  • Previous endoscopic procedures (include report)
  • Relevant radiology/nuclear medicine investigations (include report)

Additional referral information (Useful for processing the referral)

  • Psychological/Psychiatric treatment outcomes
  • Medication outcome – beneficial or adverse effects (e.g. prokinetics, anti-emetics, anti-diarrhoeal etc.)

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.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)
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