Gastroenterology team referral
From WardWiki - Foundation Doctor Helper
A gastroenterology team referral should happen at any point where the primary team caring for the patient has exceeded its professional capacity to manage the patient independently. Acute Upper GI Bleed, Non-obstructive jaundice, inflammatory bowel disease and alcoholic liver disease are common reasons for referral. All jaundice in the UK is obstructive until proven otherwise.
The gastroenterology team referral checklist will allow relevant information to be gathered and presented logically and clearly, making this often intimidating referral pleasant for all. It is very unusual for a neurosurgeon to visit an acute referral outside their base hospital, the objective must be clearly established as to whether telephone advice is sought or an inpatient transfer is to be arranged.
When to refer to a gastroenterology team
This is not an easy decision. Excessive referrals impair the efficiency of patient care delivery whereas delayed referrals affect specific patients. Upper GI bleeds that are stable and not requiring blood transfusion do not require immediate referral but will need OGD at some point prior to discharge. Non-obstructive jaundice is best seen as an inpatient as is alcohol toxicity if a withdrawl regime is needed.
- Have up to date observations and fluid balance chart to hand.
- General medical history - particularly noting alcohol intake, hepatitis status and any known autoimmune diseases, do not blindly screen for these without consultant direction.
- Full systemic examination
- Previous endoscopies and interventions such as variceal banding should be noted
- Imaging - results of AXR and ultrasound as undertaken.
Let the patient know the referral has been made if possible. The sudden, unexpected appearance of a new face, especially when senior and serious in manner, can be very frightening to patients. Decide early what the objective of the referral is. Imagine the irritation caused should a referral be made to cardiology for stable angina, or to an orthopaedic surgeon for a sore knee in a known arthritis patient. The referral should be goal directed as follows:
- Telephone consultation advice
- A plan to take over a patient - avoid the temptation of pressing this, especially if a senior asks this of you. It is rude and earns a sorry reputation. The cowardice of a senior in handling this indirectly is not noticed as much as a foundation doctor who attempts to intimidate another team into action. Any strong drive to transfer a patient's care should be taken amicably and electively at the consultant level.
- One can be assured a gastroenterology team is most thorough in its approach and more than capable of deciding which patients' care to take over.
Always write a summary of events. Documentation that a referral has been made is important but for the team to then trawl through notes, often late in the afternoon, is a poor example of teamwork. Avoid this.