Abdominal pain red-flag referral checklist

Urgency tier

• Immediate ED assessment for peritonitis, instability, significant GI bleeding, sudden severe/disproportionate pain or suspected obstruction; use EMS for shock or unsafe transport.
• Urgent reassessment for persistent severe pain; expedite specialist workup for stable non-acute weight loss or unresolved symptoms after emergency causes have been assessed.
• Routine referral for non-acute persistent symptoms needing specialist workup.

Minimum pre-referral workup

• Emergency transfer must not wait for completion of this checklist.
• Focused abdominal exam and documented progression timeline.
• Baseline labs and pregnancy test when clinically relevant.
• Medication history, red-flag symptom review, and hydration assessment.

Referral packet checklist

• Structured history with pain location, timing, severity, and associated symptoms.
• Objective findings, labs/imaging completed, and response to initial management.
• Current medication list and comorbidity profile.

Pre-referral optimization tasks

• Reinforce return precautions for worsening pain, fever, bleeding, or syncope.
• Optimize hydration and symptom diary documentation before specialist review.
• Arrange interim follow-up while waiting for referral outcome.

References

• Emergency Care BC Abdominal pain return precautions (2024) (opens in a new tab)
• Emergency Care BC Mesenteric ischemia (2022) (opens in a new tab)
• Emergency Care BC Ectopic pregnancy diagnosis (2020) (opens in a new tab)

Something out of date or unclear? Suggest an update. Leave out any patient details.