Use my hospital eye service’s remote support platform?

This can be helpful for unusual presentations or where you are not sure whether a referral or treatment is necessary, and in cases where an ophthalmologist can provide reassurance or direction in how to manage the patient.

Here are the key considerations when using the service.

Asking for advice

From the perspective of an optometrist seeking advice from an official NHS system, as long as the information you provide about the patient is accurate, then the clinician who provides the advice to the optometrist is responsible – in the same way that if you refer a patient appropriately, you are transferring responsibility for their ongoing care. It is important that the system has a visible audit trail to ensure it is clear who has provided advice, and in what capacity.

Requesting advice through a personal contact, for example via text message or similar, is not recommended. In this case you cannot ensure that the advice will be accurate, that those providing advice have the necessary expertise, that the information will be received in a timely manner, or that there is a robust audit trail.

In this instance the optometrist asking for advice would still be responsible for any decisions taken, and it would not provide the same transfer of responsibility. This could lead to a situation where all involved are placed at unnecessary risk.

What information to provide

It is important to provide all the required information, to ensure that robust decision making can take place. It is especially helpful to provide good quality images if possible, and if they are relevant – for example, for a suspicious eyelid lesion or retinal finding.

Not providing enough information can lead to an unnecessary delay in receiving an answer or could lead to incorrect advice being given. The receiving clinician should ask for the information if they require it to make a decision, however.

Recording requests and responses

You should keep full records of any request for advice that you send, and the reply received, including details of the clinicians involved. This will also help as a prompt if you need to chase a response which has not been received. If it is not possible to print or save the reply to a file, you may have to take a screenshot. In the event of a complaint, this information may help to demonstrate that you were following advice, and could act as evidence of the information you provided.

It is important that all referrals are made in line with the worst-case differential diagnosis

The HES system you are using should have a protocol so that requests are responded to within an appropriate time frame. If you do not receive a response within a suitable time period you should refer the patient appropriately, taking account of any delay when deciding upon the urgency. It is important that all referrals are made in line with the worst-case differential diagnosis. For example, if the two differential diagnoses were wet age-related macular degeneration (AMD) and central serous retinopathy, your referral urgency should be based on wet AMD.

When not to use a remote HES advice platform

Requesting advice and guidance in this way is most appropriate for patients with low-risk problems such as lid lesions, minor corneal problems, or unusual retinal findings.

The main category of conditions that are not suitable for a remote guidance service are patients who may have an urgent, or particularly time-sensitive problem. In this case, the delay in receiving a reply and then referring the patient could have a negative impact on the outcome.

Advice and guidance will, in most instances, not be suitable for conditions where there is a risk of serious pathology such as wet AMD or a retinal tear or detachment.

For more information or to discuss a specific situation, please contact the AOP’s clinical and regulations team on [email protected]

With thanks to Kevin Wallace for his assistance in this article.