Liver cirrhosis
Emergency department referrals
All urgent cases must be discussed with the on call 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.
Potentially life-threatening symptoms suggestive of:
- Acute severe GI bleeding
- Acute liver failure: (acutely abnormal liver blood tests in absence of cirrhosis, associated with development of coagulopathy and hepatic encephalopathy)
- Sepsis in a patient with cirrhosis
- Severe encephalopathy in a patient with liver disease
- New significant renal dysfunction in a patient with cirrhosis
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
- Suspected advanced liver disease/ cirrhosis (on clinical features, non-invasive testing, imaging, or histology) with concerning features
- Evidence of liver decompensation e.g. jaundice and/or ascites and/or encephalopathy
- Child-pugh score >B7, Model for End-stage Liver Disease (MELD) score >9
- Elevated alpha-fetoprotein or space occupying lesion on imaging
Category 2
Appointment within 90 days is desirable
- Suspected advanced fibrosis or cirrhosis on clinical features, non-invasive testing, imaging, or histology without concerning features
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
- Refer to HealthPathways or local guidelines
Medical management
- Screening and vaccination for Hepatitis A virus
- Screening and vaccination for Hepatitis B virus
- Six monthly surveillance for hepatocellular cancer with ultrasound and AFP if advanced fibrosis/cirrhosis and treatment
- Address substance misuse (alcohol, illicit and prescription drugs)
- Consider cessation of hepatotoxic medication, herbal preparations, supplements, NSAIDs and benzodiazepines
- Lifestyle modification (increased activity, dietary, weight, smoking)
Referral requirements
A referral may be rejected without the following information.
- General referral information including details of presenting issues
- Comorbidities and past medical history
- Family history of liver cancer or other liver disease/s
- Alcohol and medication history (including non-prescription, herbs and supplements)
- Risk factors for viral hepatitis
- Height, weight and BMI
- Recent (<6 months) upper abdominal ultrasound or CT report. Surveillance imaging to remain up to date whilst on wait list
- ELFT, FBC, INR results less than 3 months old
- Alpha fetoprotein (AFP) results (<6 months)
- HBV, HCV and iron studies results
Additional referral information (useful for processing the referral)
- Previous endoscopic procedure report
- Record of previous liver function tests, liver fibrosis assessment (elastography, direct serum markers), imaging and/or liver biopsy 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.
- 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.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
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
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org