Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists

Abstract

ObjectivesMany chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a public hospital-based integrated eye care model, this study aims to evaluate the quality of referrals for new patients through information content, assess triage decisions of newly referred patients and evaluate the consistency of referral content for new patients referred multiple times.DesignA retrospective and prospective review of all referral forms for new patients referred to a public hospital ophthalmology clinic between January 2016 and September 2017, and September 2017 and August 2018, respectively.SettingA referral-only public hospital ophthalmology clinic in metropolitan Sydney, Australia.Participants418 new patients on existing non-urgent wait lists waiting to be allocated an initial appointment, and 528 patients who were newly referred.Primary and secondary outcome measuresThe primary outcome was the information content of referrals for new patients. The secondary outcomes were triage outcomes for new incoming referrals, and the number of new patients with multiple referrals.ResultsOf the wait-listed referrals, 0.2% were complete in referral content compared with 9.8% of new incoming referrals (p<0.001). Of new incoming referrals, 56.7% were triaged to a non-urgent clinic. Multiple referrals were received for 49 patients, with no change in the amount of referral content.ConclusionsMost referrals were incomplete in content, leading to triage based on limited clinical information. Some new patients were referred multiple times with their second referral containing a similar amount of content as their first. Lengthy wait lists could be prevented by improving administrative processes and communication between the referral centre and referrers. The future implementation of an integrated eye care model at the study setting could sustainably cut wait lists for patients with chronic eye conditions.

Strengthening Saudi Arabia’s Primary Health Care through an e-Referral System: A Case Study

“…In fact, some dental and ophthalmologic specialties are often available from hospitals and are mainly provided by specialised health professionals. However, the literature suggests that some patients are improperly referred, consuming health-care resources that could have been used elsewhere, and that some patients are inappropriately treated in primary care settings when they should have received specialist care [ 15 , 16 , 17 , 18 , 19 ]. The costs associated with inappropriate referrals to secondary care are unnecessary, notwithstanding the effects on waiting lists.…”