New Referral Guidelines and/or Algorithms for Diabetes, Eating Disorders, Urology, Otolaryngology and Gastroenterology

Diabetes: Please Call Us When Referring New Patients With Type 1 or 2

When referring patients who are newly diagnosed with diabetes, either type 1 or 2, we ask that you please call our Provider-to-Provider Line at 206-987-7777 to speak with the endocrinologist on call.

• This is a safety check to ensure patients who need to be seen urgently are prioritized for scheduling.
• Our provider will help triage your patient into the most appropriate education category. We have three different education tracks of varying intensity depending on whether the patient is more likely to have type 1 or 2 diabetes or has already received some education but may need a refresher or supplementation.

For more information, see our updated information at:

• Algorithm for newly diagnosed diabetes patients
• Endocrinology and Diabetes: Refer a Patient page

Eating Disorders: All Referred Patients Will Be Seen at Least Once

To address the rising number and severity of patients with eating disorders, beginning January 1, 2022, all patients referred to the Eating Disorders Clinic will be offered a one-time telehealth visit with the option to join a waitlist for ongoing care based on the fit of services and family interest.

Patients must have a complete referral from their PCP before they can schedule the one-time telehealth visit. A complete referral will contain:

• New Appointment Request Form (PDF) (DOC)
• Orthostatic vital signs with resting heart rate – within last 14 days
• Weight and height – within last 14 days
• Growth charts
• Labs (CBC, ALT, T4, TSH, electrolytes, BUN/creatinine, calcium, magnesium, phosphorus, sed rate) – within last 30 days
• EKG within last 30 days

For more information, see Refer a Patient: Eating Disorders. You may also like to read Dr. Yolanda Evans’ op-ed in the Seattle Times last month: “3 Key Steps for Legislators to Address the Crisis of Youth Mental Health.”

Urology, Otolaryngology: Updated Antibiotic Guidance for Five Conditions

The following algorithms now have updated guidelines for antibiotic treatment:

• Acute otitis media
• Acute otitis media with treatment failure
• Acute pharyngitis
• Acute sinusitis
• Urinary tract infection

These and approximately 50 more algorithms and other PCP resources are available on our website at seattlechildrens.org/algorithms. They were developed by Seattle Children’s specialists with input from primary care physicians and are designed to answer the top three to five clinical questions received by our specialty clinics. Please visit and bookmark the site.

To help us improve these resources, if you find an algorithm or other resource unclear in any way, please contact us at physician.relations@seattlechildrens.org.

Gastroenterology: Referrals for Constipation, GERD and Abdominal Pain

After resuming accepting referrals earlier this year for patients with nonurgent constipation, GERD and functional abdominal pain, we have seen GI and Hepatology referrals steadily rise. Wait times for new patient visits are becoming incongruent with our commitment to timely care.

• General GI – three-month wait for a new patient appointment (down from six months a year ago)
• Hepatology – five-month wait for a new patient appointment

We have purposefully decided to continue accepting referrals for the above conditions during this difficult access time because we understand how impactful this is to our community and your patients. We ask that our referring providers help explain to families why wait times are prolonged and help manage their condition prior to referring them to the GI clinic, within reason and patient safety.

Extensive clinical care resources are available on our GI/Hepatology website, including:

Constipation

• The Functional Constipation Clinical Protocol (PDF), developed by Seattle Children’s specialists in collaboration with community providers, can help you determine whether your patient should be referred to a specialist or treated in primary care.
• Algorithm for Functional Constipation (p. 12 in the document above)
• Guideline for families, including education materials to help understand and manage their child’s constipation
• Parent booklet about constipation from St. Louis Children’s
• Dosage Tables
  • Polyethylene Glycol (MiraLAX) Dosage Table
  • Severe or Chronic Constipation: Polyethylene Glycol (MiraLAX) Dosage Table
  • Chronic Constipation Treatment 3-Day Cleanout and Maintenance Dosing Tables
  • Bowel Cleanout and Maintenance Program at a Glance

Abdominal Pain

• See Functional Constipation Clinical Protocol above
• Consider the following screening tests: CBC, ESR, CRP, albumin, BUN/Cr, ALT, TTG IgA, total IgA, TSH and stool Helicobacter pylori.
• Consider abdominal imaging with ultrasound, upper gastrointestinal series or other if concerning symptoms for gallbladder pathology, abnormal GI anatomy or extraintestinal sources of symptoms.
• Education materials to help families understand and manage their child’s abdominal pain:

• • Functional Abdominal Pain: How to help with your child’s chronic abdominal pain (Spanish)
  • Abdominal Pain – Female
  • Abdominal Pain – Male
• Seattle Children’s article: “Abdominal Pain in Kids – Anxiety-Related or Something More?”
• Free mobile app for teenagers experiencing pain
• Pain associated with chronic vomiting, chronic diarrhea, bleeding, weight loss, or significant lab abnormalities is considered an urgent referral. Please include these details in the referral or contact our GI providers.

Physiological Gastroesophageal Reflux

• Algorithm for GERD in infants (<12 months)
• Algorithm for GERD in children ages 1+
• A guideline for families that includes education materials to help understand and manage their child’s reflux: “Reflux (Spitting Up)”
• Seattle Children’s handout, “Gastroesophageal Reflux: Helping Your Baby.”
• Gastroesophageal Reflux Disease (GERD): Parent’s Take-Home Guide from GI Kids (Spanish)
• Consider recommending a food and emotion diary to correlate reflux symptoms with certain foods and stressors.
• Consider a trial of acid suppression for two to four weeks.
• Chronic vomiting, vomiting with weight loss and dysphagia are considered a more urgent referral. Please include these details in the referral or contact our GI providers.

If you’re not sure whether to refer your patient or have questions about patient management, please call our Provider-to-Provider Line at 206-987-7777 for the GI specialist on-call. Call this line also if you feel your patient’s wait time for an appointment is too long given their condition, and we will help.

We are committed to seeing patients in a timely manner. In addition to hiring new doctors this year, Hannibal Person, MD (Bellevue, main campus) and Katelyn Saarela, DO (main campus), we are triaging incoming referrals and adding at least two new GI providers in 2022.