title: Criteria for Referring Patients With Outpatient Gastroenterological Disease for Specialist Consultation: A Review of the Literature.
abstract: BACKGROUND
  Demands on gastroenterology are growing, as a result of the high prevalence of digestive diseases, the impact of colon cancer screening programs and an aging population. Prioritizing referrals to gastroenterology would assist in managing wait times. Our objectives were (1) to assess whether there were consistent criteria to guide referrals from family physicians for gastroenterological outpatient consultation and (2) to determine if there were different levels of urgency or priority in referral criteria.
  
  
  METHODS
  We conducted a scoping review, searching Medline, Embase and Cochrane databases from 1997 to 2009, using the terms referral, triage, consultation and at least one from a list of gastroenterology-specific search terms. Of 2978 initial results, 51 papers were retrieved, and 20 were retained after review by two reviewers. Additional publications were identified through hand searches of retained papers, website searches and nomination by a panel of specialists.
  
  
  RESULTS
  Thirty-four papers, reports or websites were retained. No referral criteria covered the spectrum of disorders that might be referred by family physicians to gastroenterologists. Criteria for referral were most commonly listed for suspected colorectal cancer, followed by suspected upper GI cancer, hepatitis, and functional disorders.
  
  
  CONCLUSIONS
  A clinical panel comprised of gastroenterologists and primary care providers, informed by this literature review, are completing the work of formulating a Gastroenterology Priority Referral Score, and plan to test the reliability and validity of the tool for determining the relative urgency for referral from primary care to gastroenterology.
authors.affiliation: Data Integration, Measurement & Reporting, Alberta Health Services, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: De Coster
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Cepoiu-Martin
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Carla
authors.initials: C
authors.lastname: Nash
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Tom W
authors.initials: TW
authors.lastname: Noseworthy
keywords: Family physicians; Gastroenterology; Gastrointestinal diseases; Referral and consultation; Review