Unintentional weight loss

Emergency department referrals

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

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000

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, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region:

Uncontrolled hyperthyroidism with risk of thyroid storm
Vomiting, dysphagia or odynophagia suggesting oesophageal or gastric outlet obstruction
Associated severe electrolyte abnormalities (K+ <3.0 mmol/l, corrected Ca+ <1.6 or >3.0 mmol/l, Mg+ <0.5 mmol/l, PO4- <0.4mmol/l)

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

Significant weight loss (≥10% of body weight in previous 6 months) without anaemia*
Clinical features or test results suggestive of disseminated malignancy
Marked cachexia or malnutrition
Suspected malabsorption syndromes
Post-prandial angina
Uncontrolled anxiety or depression or pain syndromes causing marked loss of appetite and associated weight loss
BMI <15 Kg/m^²^*

Category 2

Appointment within 90 days is desirable

Unexplained weight loss (5-10% of body weight in previous 6 months)*

* 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

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

Unintentional weight loss <5% can be managed in primary care.
If patient has anaemia please refer to Anaemia condition in the General Medicine referral guidelines or the Iron deficiency condition within the Gastroenterology referral guidelines.
Available depression tools include:
- PHQ-2 – 2 question screening tool
- K-10 – 10 question screening tool
If an eating disorder is suspected or confirmed consider referring to the Queensland Eating Disorder Service document: A guide to admission and inpatient treatment for people with eating disorders in Queensland
Consider referring to the Metro North HHS Refeeding Syndrome Identification and Management in Adults guideline

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

Relevant medical history and co-morbidities
Full list of current medications including non-prescription medications
Weight, height and BMI
Exact weight loss and time period of loss
Any associated symptoms (e.g. cough, abdominal pain, change in bowel habits)
Alcohol and drug history (including smoking)
Assessment of mood and social situation (depression is a common cause of weight loss)
Appetite and recent dietary changes

Pathology and Test Results

FBC, ELFT, ESR/CRP, TSH, iron studies, vitamin B12 & folate results
Coeliac disease antibodies in younger patients (aged < 40 years old) with associated iron deficiency

Additional Referral Information (Useful for processing the referral)

History and Examination

Food intolerances or avoidances and abnormal eating behaviours
Gastrointestinal or oral symptoms especially dysphagia, diarrhoea, gum disease, poor dentition, loss of taste

Pathology and Test Results

HbA1c results (if diabetic)

Imaging and reports

CXR (if indicated)

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