Diarrhea referral checklist

Urgency tier

• Immediate ED assessment for severe dehydration, hypotension, bleeding with systemic toxicity, confusion or suspected hemolytic uremic syndrome; use EMS for shock or unsafe transport.
• Expedited referral for persistent symptoms with weight loss or treatment failure.
• Routine referral for stable chronic/recurrent symptoms after initial workup.

Minimum pre-referral workup

• Emergency transfer must not wait for completion of this checklist.
• Stool pattern, duration, red-flag symptoms, and hydration status.
• Exposure history (travel, food, antibiotics) and immune-risk profile.
• Baseline investigations and response to supportive treatment.

Referral packet checklist

• Symptom timeline with stool characteristics and associated systemic signs.
• Completed tests and objective trend data.
• Current medications, comorbidities, and infection-exposure history.

Pre-referral optimization tasks

• Continue an individualized hydration/electrolyte plan only when oral intake is safe; significant renal or cardiac disease requires tailored fluid advice.
• Reinforce return precautions for worsening weakness, bleeding, or fever.
• Plan interim follow-up while awaiting specialist assessment.

References

• BC Guidelines Infectious diarrhea investigation (2022) (opens in a new tab)
• Emergency Care BC Oral rehydration for adults (2020) (opens in a new tab)
• IDSA Infectious diarrhea guideline (2017; US guidance) (opens in a new tab)

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