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Urgent Gastroenterology Services

Checked: 23-08-2018 by Rob Adams Next Review: 23-08-2019

NBT Urgent Gastroenterology Service

NBT have a RAS service available via eRS to facilitate urgent outpatient appointments for patients with suspected or confirmed IBD. It should not be used for patients with other urgent gastroenterology conditions. Once the patient has been referred, and if they fulfil the urgent criteria, they will be offered an appointment within 4 weeks. This service may also be appropriate for some patients who would otherwise be admitted to hospital. This service should not be used for patients with suspected cancer - (please check qFIT prior to referral if appropriate).

RAS referrals will be triaged by a consultant and if a direct access colonoscopy or an alternative pathway is felt to be more appropriate then the referral may be returned asking the referrer to arrange this. This is because the current secondary care service has long waits for endoscopy at present and therefore the direct access providers can often provide quicker access to a diagnosis. This process should become more streamlined in due course.

The criteria for this urgent service are:

Suspected IBD

Any of abdominal pain or discomfort, bloating, change in bowel habit (such as diarrhoea, with or without rectal bleeding) that have been present for at least 6 weeks

AND

A faecal calprotectin of > 250.

AND

A negative qFIT (recommended) - to help exclude lower GI malignancy - if positive then please consider 2WW referral - see Red Flags below.

Confirmed IBD

Diagnosis made by endoscopy at an alternative treatment centre

AND

One or more of the following:

4 or more stools/day
Pyrexia
Heart rate > 90
Anaemia
Raised CRP (>20 indicates moderate flare and >30 indicates severe flare)

For patients who do not meet the criteria for the urgent service please refer for direct access colonoscopy via eRS initially to confirm diagnosis (if clinically appropriate) and then refer routinely to IBD clinic if diagnosis is confirmed (see Inflammatory Bowel Disease section)

If acute severe colitis is suspected then please discuss with on call gastroenterology team as admission may be necessary (see red flag section below).

Referral

To access the above service please submit via eRS and request the NBT Urgent Gastroenterology Service.

This service is available via a RAS so that referrals will be triaged in secondary care and returned if criteria are not met.

Urgent Gastroenterology (excluding NBT)

Other providers do not have a dedicated urgent clinic for patients with suspected IBD but if the patient has symptoms of IBD and Faecal Calprotectin of >250, or diagnosis of IBD has been confirmed by direct access colonoscopy, then please mark referral as urgent and it should be triaged by the gastroenterology team and seen as quickly as possible in their clinic.

If acute severe colitis is suspected then please discuss with on call gastroenterology team as admission may be necessary (see red flag section below).

Referral

Urgent referrals to gastroenterology should be submitted via eRS and the preferred provider should be stated.

If no preferred provider then patients may be offered option of the following services which are mapped on eRS:

Gastroenterology clinic - UHB
Gastroenterology medical - WGH
Gastroenterology lower GI (medical not surgical) - RUH, Bath

Red Flags

Suspected Malignancy

Patients with suspected lower GI cancer or positive qFIT should be referred via the Urgent Suspected Cancer pathway (Direct to test, if appropriate)

Acute Severe Colitis

Patients with acute severe colitis may need more immediate treatment or admission so please discuss with on call gastroenterology team (IBD nurse or on call registrar/consultant).

Definition:

More than 6 bloody stools/day

AND

One or more of the following:

Pulse > 90
Temperature > 37.8
CRP > 45
Haemoglobin < 105 g/l

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