Herefordshire optometrist Wendy Newsom worked in the hospital setting for 14 years before moving back to a role in the community. During this time, she was responsible for reading and triaging all referral letters that came into the hospital; firstly in Cambridgeshire and then in Bedfordshire.
Going through hundreds of referral letters on a weekly basis, Ms Newsom’s role was to read each one and make a decision based on the information that was in the letter as to what level of urgency the patient needed to be seen and in which clinic they should be booked.
Over the years, Ms Newsom saw a wide range of different referral letter writing approaches by professionals referring into the hospital setting and has supported optometrists in advancing their skills in this area.
“Providing optometrists with support so that they are confident when referring is important,” Ms Newsom said.
Refining referral skills
In Ms Newsom’s experience an appropriate referral is written clearly, contains only relevant information and provides a proposed course of action.
Sharing advice on what information should be provided in a referral letter, Ms Newsom encourages optometrists to give a provisional diagnosis and be clear about why they are referring.
The word ‘relevant’ is of particular importance, Ms Newsom said, sharing: “The hospital really wants to know what the presenting symptom or asymptomatic finding is, and how long the symptom has been going on for. They also want to know what you have seen and what you think it is.”
Ms Newsom encourages optometrists to be very clear about what they want from the referral in their letter. “You can say, ‘I think this patient will benefit from being seen in a specialist retina clinic,’” she highlighted.
The optometrist also emphasised that there is also nothing wrong with being unsure. “If you don’t know what might be wrong, say, ‘I am unsure what this is’,” she said. “It is often helpful to discuss a difficult case with a colleague,” she added.
“Referral letters should be clear, they should contain only the relevant information and they should not be too long”
When working in both Cambridgeshire and Bedfordshire, Ms Newsom found that bringing community optometrists and hospital representatives together to discuss the content of a referral was very successful.
A further initiative led by Ms Newsom in these areas was the establishment of a telephone line that was designed to support optometrists with their referral decision-making. “Optometrists could simply call up and get advice,” she said.
Following these initiatives, Ms Newsom said: “Ophthalmologists began to reply, and trust between both parties grew.”
In Worcestershire, optometrists have worked with ophthalmologists to produce written guidance on referrals for practitioners in their area. The guide, Ms Newsom said, covers what is an emergency, what is urgent and what is routine. “It has been an important piece of work in the area as it has been a great help to optometrists and also helped build relationships between the two professions,” she said.
“Future IT systems will allow for the better transfer of clinical information from the hospital to the community, which is vital as optometrists take on more of the ophthalmology workload in the community”
Community optometrists who refer into the hospital setting can understandably feel frustrated when they do not hear back from the ophthalmologist.
While a well written, appropriate referral letter helps to encourage ophthalmologists to write back, Ms Newsom emphasised that: “Future IT systems will allow for the better transfer of clinical information from the hospital to the community, which is vital as optometrists take on more of the ophthalmology workload in the community.”
Ms Newsom highlighted that it is good practice for an optometrist to audit the results of their referrals. “Keeping a spreadsheet of referrals made and reflecting on the outcome when feedback is received helps us learn from our referral decisions,” Ms Newsom explained. “If feedback is not received, then it provides a powerful case that a Local Optical Committee could take to their hospital trust to show how little feedback is given from secondary care,” she added.
Discussing the importance of appropriate referrals, Ms Newsom said: “A good referral is very much in the patient’s best interest and it is our duty to get it right for them.”