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Referrals

Nausea/vomiting referral checklist

Referral checklist for persistent nausea/vomiting with dehydration or unresolved diagnostic concern.

Last reviewed 2026-02-07|nausea | vomiting | gastroenterology

At a glance

Fast checkpoints for point-of-care decisions.

Minimum pre-referral workup

Symptom chronology, oral-intake tolerance, and dehydration assessment.
Focused abdominal exam and high-risk comorbidity review.
Baseline tests completed and response to initial outpatient management.

Urgency tier and escalation triggers

Same-day escalation for severe dehydration, GI bleeding, persistent severe abdominal pain, or altered mental status.
Expedited referral for persistent vomiting with nutritional compromise or unresolved etiology.
Routine referral for stable but prolonged symptoms after initial workup.

Referral packet essentials

Duration/frequency pattern and triggering factors.
Objective findings, investigations performed, and treatment response.
Current medication list and relevant comorbid context.

Pre-referral optimization tasks

Reinforce hydration targets and return precautions for deterioration.
Review medication contributors and stop non-essential triggers where safe.
Arrange interim follow-up pending specialist assessment.

Referral readiness checks

Confirm workup completeness, urgency tiering, and referral packet quality before submission.

Minimum pre-referral workup

Verify baseline investigations are complete and recent.

Symptom chronology, oral-intake tolerance, and dehydration assessment.
Focused abdominal exam and high-risk comorbidity review.
Baseline tests completed and response to initial outpatient management.

Urgency tier and escalation triggers

Separate urgent pathways from routine referral flow.

Same-day escalation for severe dehydration, GI bleeding, persistent severe abdominal pain, or altered mental status.
Expedited referral for persistent vomiting with nutritional compromise or unresolved etiology.
Routine referral for stable but prolonged symptoms after initial workup.

Referral packet essentials

Include all mandatory data to reduce rejected referrals.

Duration/frequency pattern and triggering factors.
Objective findings, investigations performed, and treatment response.
Current medication list and relevant comorbid context.

Pre-referral optimization tasks

Address interim safety, optimization, and follow-up steps before handoff.

Reinforce hydration targets and return precautions for deterioration.
Review medication contributors and stop non-essential triggers where safe.
Arrange interim follow-up pending specialist assessment.

Jump to

Minimum pre-referral workup Urgency tier Referral packet checklist Pre-referral optimization tasks

Minimum pre-referral workup

Symptom chronology, oral-intake tolerance, and dehydration assessment.
Focused abdominal exam and high-risk comorbidity review.
Baseline tests completed and response to initial outpatient management.

Urgency tier

Same-day escalation for severe dehydration, GI bleeding, persistent severe abdominal pain, or altered mental status.
Expedited referral for persistent vomiting with nutritional compromise or unresolved etiology.
Routine referral for stable but prolonged symptoms after initial workup.

Referral packet checklist

Duration/frequency pattern and triggering factors.
Objective findings, investigations performed, and treatment response.
Current medication list and relevant comorbid context.

Pre-referral optimization tasks

Reinforce hydration targets and return precautions for deterioration.
Review medication contributors and stop non-essential triggers where safe.
Arrange interim follow-up pending specialist assessment.

References

Choosing Wisely Canada recommendations