Manage a previous referral when a hospital appointment has been delayed?

Optometrists have a duty of care to their patients, or in other words, they have a responsibility to provide care to a reasonable standard and to always act in their best interests, and this would include making an onwards referral with the correct urgency.

In this scenario, the duty of care extends to making another referral with greater urgency than would normally be indicated, as the patient has already been delayed. A routine referral was reasonable at the initial appointment, but now that time has passed and the patient’s condition has potentially worsened, to satisfy your duty of care you may need to make another referral on an urgent basis. If you do this, you should explain why you have escalated the urgency so the hospital understands the situation and why you have marked this referral as more urgent than they may expect.

Clear communication

All referral letters should make it clear the urgency with which you would like the patient to be seen. Avoiding ambiguity is important and explaining why the referral is urgent is helpful. A common mistake is leaving ‘routine’ at the top of the letter and then saying in the body of the text that it is urgent. This can lead to the referral being inappropriately triaged.

It is important to make it clear in your referral why the patient may now be considered urgent. Highlighting the progression of disease and threat to sight all help avoid the referral being ignored. Also try not to write an essay, as there is a risk that busy clinicians might not pick out all the important information. Stick to the key points and be as direct as possible.

A common mistake is leaving ‘routine’ at the top of the letter and then saying in the body of the text that it is urgent. This can lead to the referral being inappropriately triaged

You should explain to the patient why they need to be seen at the urgency requested, and ensure they are clear so that if they do not receive an appointment they know to follow it up, or let you know. This is referred to as ‘safety netting advice’ and should be noted on the record. For example: ‘I explained to the patient that they should receive an appointment within two weeks, but if they don’t to let the practice know so that we can follow up the referral.’ It is also helpful to provide the advice in writing to the patient, to avoid any confusion.

In instances where the appointment is still delayed, it can be helpful to write to the patient’s GP explaining the concerns. In some instances, the GP may be able to help with the escalation process.