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Direct Access Endoscopy (DAE) - Colonoscopy

Useful management information for DAE - Colonoscopy

The Direct Access Endoscopy (DAE) pathway:

  • provides patients with the most direct pathway to public endoscopy services in the region
  • reduces waiting time for patients who do not require a specialist appointment prior to the procedure
  • is the only direct method and point of entry to each Metro South Health facility endoscopy list

Suitable patients can be referred to DAE for: 

  • suspected malignancy
  • positive FOBT
  • follow-up or surveillance procedures (no greater than 3 months from due date)
  • strong family history of gastrointestinal cancers or
  • confirmation of coeliac disease with positive serology (or strong suspicion despite negative serology).

Once the procedure is completed, the proceduralist will provide the referring GP with the histology results along with a brief report of the findings and recommendations for follow up.

Clinical Resources: 

Minimum referral criteria for DAE - Colonoscopy Does your patient meet the minimum criteria?

Does your patient meet the minimum referral criteria?

Category 4
(appointment within 30 calendar days)
  • Mass palpable on abdominal or rectal examination 
  • Positive faecal occult blood test (iFOBT) asymptomatic 
  • Severe abdominal pain with presence of concerning features* or significant impact on activities of daily living 
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and /or presence of concerning features 
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and with presence of concerning features 
  • Rectal bleeding with presence of concerning features 
  • Unexplained weight loss and presence of concerning features* 
  • Abnormal radiology 
Presence of following *concerning features:
  • Dark blood coating or mixed with stool 
  • Bloody or nocturnal diarrhoea 
  • Weight loss, ≥5% of body weight in previous 6 months 
  • Abdominal / rectal mass on clinical examination or abnormal imaging 
  • Persistent abdominal pain 
  • Iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women 
  • Patient and family history of bowel cancer (1st degree relative <55 years old) 
  • iFOBT or calprotectin +ve 
 
NB for patients with symptoms suggestive of colorectal cancer, the total time from first healthcare presentation* to diagnostic colonoscopy should be no more than 120 days. Diagnostic intervals greater than 120 days are associated with poorer clinical outcomes. 
 
*First healthcare presentation is defined as the date of presentation in general practice with symptoms suggestive of colorectal cancer or positive iFOBT for screening. (Cancer Council Australia, 2017) 
Category 5
(appointment within 90 calendar days)
  • Anaemia or iron deficiency with no obvious cause and/or persisting despite correction of potential causative factors and in the absence of concerning features* 
  • Altered bowel habits with progressive or persistent symptoms that are significantly impacting activities of daily living despite medical management and in the absence of concerning features 
  • Rectal bleeding in the absence of concerning features*
  • Unexplained weight loss in the absence of concerning features* (see Category 4)
Category 6
(appointment within 365 calendar days)
  • Family history of colorectal cancer (CRC) in patients with one first-degree relative diagnosed with CRC <55 years, or two first- or second-degree relatives (on the same side of the family) diagnosed with CRC at any age 
Category 9
(Surveillance)
  • Colonoscopy surveillance after polypectomy 
  • Post-operative colonoscopy one year after curative resection for colorectal cancer 
  • Whose initial diagnosis was made <40 years 
  • With suspected but un-identified hereditary colorectal cancer syndromes 
  • With multiple synchronous cancers or advanced adenomas at initial diagnosis 
  • IBD surveillance 
  • Genetic cancer surveillance i.e lynch syndrome, familial adenomatous polyposis (FAP), hereditary nonpolposis colorectal cancer (HNPCC)
If your patient does not meet the minimum referral criteria
  • Consider other treatment pathways or an alternative diagnosis
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • 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

Standard referral information To be included in all referrals

Reason for request

  • 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

Relevant clinical information about the condition

  • 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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • 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.)
     

Eligibility criteria for DAE - Colonoscopy

  • Under 75 years of age (provide ECG for patients over 50 years old)
  • BMI under 35
  • Not on anticoagulation/antiplatelet therapy (including but not limited to warfarin, clopidogrel)
  • No prior conditions of anaesthetic/procedural risks (including but not limited to IV access complications, sleep apnoea, implanted defibrillator)
  • No alcohol or drug dependency
  • No major comorbidities (including but not limited to cardiovascular, respiratory, renal dysfunction). Only eligible to ASA PS1 and some ASA PS2 (further assessment required)

Essential referral information for DAE - Colonoscopy

  • Please complete Direct Access Endoscopy Referral Form (PDF, 1.11 MB) (electronic templates are available for Best Practice and MD here)
  • Pathology results may also be required dependent on patient’s symptoms (please see referral form). 
  • Please discuss/complete the Colonoscopy consent form with your patient and ensure that your patient brings a hardcopy of the form when they present to the hospital for their appointment.

NB: individual Endoscopy and Colonoscopy consent forms must be completed if referring for both procedures
 

Out of catchment

Metro South 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 South 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.

Last updated 20 January 2023
Last reviewed 4 May 2017