Seven ways to improve referrals

OT collates tips on how optometrists and ophthalmologists can work together to improve hospital eye service referrals.

Get to know each other

Moorfields Eye Hospital consultant ophthalmologist, Melanie Hingorani, recommends that optometrists and ophthalmologists should meet and get to know each other.

Hull Royal Infirmary clinical director of ophthalmology, Colin Vize, also suggests that optometrists might like to visit their acute trust.

This also provides an opportunity for optometrists to understand how the hospital operates – for example how referrals are triaged and allocated to clinics – aiding clear, focused referrals.

Establish guidelines

Lead optometrist of Moorfields Eye Centre at Bedford Hospital, Rachel Thomas, emphasised the importance of secondary care providers establishing referral guidelines.

This was also highlighted by York Hospital consultant ophthalmologist, Sarah Anderson, who added that locally agreed guidelines should also include information about what an optometrist can expect after a referral is made. 

Is the referral necessary?

Herefordshire community optometrist and former hospital optometrist, Wendy Newsom, said it is important to know when not to refer a patient, and to keep up to date on the subject.

Newcastle upon Tyne Hospitals consultant ophthalmologist, Michael Clarke, highlighted that optometrists need to understand the significant capacity issues within the hospital eye services, and refrain from referring patients who will not benefit from it.

It is important to recognise when an abnormality is clinically insignificant. Referring these wastes hospital time and causes unnecessary worry to patients

Know what information to provide

Ms Newsom highlighted the importance of knowing how the hospital eye service works locally and what information needs to be provided for each condition.

She emphasised the importance of only providing the relevant information, so that the referral can quickly be triaged to the right clinic. Referrals containing too much information can be as unhelpful as those with too little.

Ms Newsom highlighted the need to clearly state the reason for the referral and to explain what the optometrist has found that is concerning them.

York Hospital consultant ophthalmologist, Sarah Anderson, added that it is useful if the optometrist knows what the different hospital clinics are and provides a suggestion about which clinic the patient should be seen at.

Keep it legible

Although it may seem obvious, ensuring that your referral can be read easily is a key point.

Ms Newsom suggested that optometrists should always type their referrals.

Make sure that the referring optometrist’s name and practice address are clear, as it is impossible for the hospital to provide feedback if they do not have this information.

Managing patient expectations

Ms Thomas emphasised that it is the shared responsibility of both hospital and community staff to manage patient expectations and anxieties.

Telling patients that they will be seen within a certain timeframe can be counter-productive.

There may be good reasons for the hospital giving the referral less urgency than the optometrist has suggested, and the patient may get unnecessarily anxious.

Feedback 

Ms Hingorani, shared the benefits of nominating an optometrist liaison within the hospital eye service and making sure that optometrists receive feedback on their referrals.

She also suggested auditing the quality of referrals and offering education through the local optical committee as a result.

Hospitals should audit the numbers of practitioners who receive a reply to their referral.