Ophthalmologist says providing referral feedback is a “no-brainer”

Since 2015, a joint policy between the Royal College of Ophthalmologists and College of Optometrists has supported the provision of feedback to optometrists following a referral.

However, many optometrists still report that they receive little or no information after a referral into the hospital eye service.

Why is this the case? How can feedback rates be improved and what is the benefit of doing this?

AOP policy adviser, Kathy Jones, interviewed ophthalmologists and optometrists with experience working within the hospital eye service to find out more about the issue. She shares her findings with OT.

Barriers to feedback

Ms Jones highlighted that while most referrals into the hospital eye service now originate from optometrists, it is GPs who generally receive the feedback on a referral.

She elaborated that healthcare and hospital information systems are set up to provide information back to doctors, with many hospital systems automatically generating a letter for the patient’s GP. This is often sent electronically as the patient’s GP details are incorporated into their electronic record, but that is not the case for their optometrist.

Ms Jones added that methods for providing feedback to optometrists are generally not electronic or automatic.

A consultant must actively request that a letter be sent or make it known to their secretary that this should be done routinely.

The optometrist’s contact details must also be accessible within the patient record and the secretary must have time to find the details, print a second copy of the feedback letter and send it.

“It is not hard to see how it could slip through the net in a busy and under-resourced hospital clinic setting,” Ms Jones highlighted.

“It would make a big difference if all hospital IT systems could include the optometrist’s details,” she added.

Improving feedback

Some hospitals have bucked this trend by setting up their own systems to boost the level of feedback provided to optometrists within the community.

A scheme established at Hinchingbrooke Hospital more than a decade ago involved the creation of a template so optometrists could refer into the hospital eye service directly.

This was originally a simple Microsoft Word document, but it is now done via Medisoft.

The referral is copied to the patient’s GP, with a request that they supply any relevant additional information about the patient.

After the appointment, the IT system creates a feedback letter including standard paragraphs and the hospital eye service staff can tick for it to go to GP, patient and optometrist. It is then printed and sent.

Within Moorfields Eye Centre at Bedford Hospital, a lead optometrist coordinates the triage of referrals and the liaison with community optometrists.

The centre aims to ensure that 90% of referrals receive replies and they audit this.

At Bedford they build into the optometry team’s time that someone will be at a desk to receive queries and provide feedback on referrals throughout the day.

Hospital optometrists will also call referrers to ask for more information about referrals, such as a differential diagnosis or greater clarity over what the optometrist would like done. 

Moorfields Eye Hospital consultant ophthalmologist, Melanie Hingorani, emphasised: “It’s a no-brainer. It’s a professional obligation to communicate back to the primary care professional – we wouldn’t dream of not replying to a GP.”

Benefits

Ms Jones highlighted that at the moment referrals vary in quality.

She observed that there can be missing clinical and non-clinical information, variable adherence to guidelines on recording diagnostic findings, illegible writing within the referral or the referral may be missing the signature/name of the referring optometrist.

“People learn from feedback and there is evidence that feedback on healthcare referrals can lead to improvement in the quality of future referrals,” Ms Jones added.

She elaborated that clear referrals that contain sufficient information for the hospital team to decide whether, when and where to see a patient can free up time in hospital clinics.

Ms Jones said that this reduces the wait times for patients with urgent needs and makes a better use of health professionals.

“This is crucial at this time of extreme pressure on NHS services,” Ms Jones concluded.