Referrals from community optometrists to the hospital eye service in England

Abstract

Purpose In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES. Methods Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De‐identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated. Results A total of 459 de‐identified referrals were extracted. The RR ranged from 3.6%–8.7%. The proportion of referred patients who were seen in the HES unit was 63%–76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%–49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%–62%. Patients received a copy of the reply in 3%–21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%–97% and were accurate in 81%–98% of cases. The referral reply addressed the reason for the referral in 93%–97% and was meaningful in 94%–99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR. Conclusions In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.

Referrals from community optometrists to the hospital eye service in Scotland and England

“…The retrospective design prevented practitioners altering referral behaviour, as might occur in a prospective study. Inevitably, grading referrals/replies for quality required subjective judgement, although measures were taken to minimise subjectivity [ 24 ].…”

“…Following a lengthy search and consideration of approximately 15 potential pairings (dyads) of CO practices and HES clinics in different areas of England and Scotland, three suitable dyads were identified in Scotland and compared with three dyads in England. Key requirements for participating dyads are detailed elsewhere [ 24 ]. In summary, typical CO practices and HES units were sought that would be supportive of the audit and did not have unusually strong links between the practice and HES.…”

“…The audit team visited each HES unit, extracting de-identified copies of correspondence relating to referrals for which no reply was found in the dyad CO practice. For referred patients who had attended the HES, but no report written, de-identified copies of relevant records were obtained [ 24 ].…”

“…A senior audit team member (dyad co-ordinator) entered key data from de-identified copies of referrals and replies in a spreadsheet [ 24 ]. Data that required clinical judgement (outcomes 1–3 in Table 1 and additional information items 4a and 4b) were subsequently graded by the audit team.…”

“…Second, after viewing any reply or the hospital record, the question was reconsidered from the overall perspective, including HES findings. To standardise the criteria for interpreting outcomes 1–3 (Table 1 ), guidelines were operationalised for 14 commonly referred conditions [ 24 ]. For each condition, common scenarios were listed and mapped to outcomes 1–3, following review from the expert panel.…”