Department of Ophthalmology, Queen Margaret Hospital, Dunfermline, Fife, UK.
Eye (Lond). 2009 May;23(5):1134-40. doi: 10.1038/eye.2008.196. Epub 2008 Jul 4.
A study to assess the feasibility, safety, and clinical effectiveness of electronic referral--with and without images--of patients directly from optometrists in primary care to the hospital eye service (HES) in contrast to the traditional paper-based referral, through the general practitioner (GP).
Three optometry practices sent consecutive referrals with images through the NHS Net to the HES. The standard General Ophthalmic Service form was electronically redesigned with additional information on patient choice for advice, appointment, or surgery. All paper referrals to the HES from the same three optometry practices before the study period were analysed (control group A) as were all paper referrals from the remaining optometrists in Fife (control group B).
A total of 346 electronic referrals were received over 18 months. 218 (63%) were classified as requiring and 128 (37%) as not requiring a HES appointment. The latter were subsequently examined with unexpected pathology found in three cases (glaucoma, macular pigment epithelial detachment, and possible peripheral retinal tear). In both groups, the major pathologies reported were macular degeneration, cataract, glaucoma, diabetic retinopathy, and abnormal retinal appearances. A total of 17 (15%) patients in group A and 26 (8.4%) patients in group B were classified as not requiring HES appointment. These control groups indicate that approximately 10-15% of paper referrals are not seen in the HES. To summarise, therefore, 63% of people referred by the optometrist directly using electronic referral (with or without images) were given a HES appointment compared to 85% of people referred through the traditional paper method (without images) through their GP.
Electronic referral with images to the HES is safe, speedy, efficient, and clinically accurate given some limitations and avoids unnecessary consultation in 37% of referrals.
评估直接将患者从初级保健的验光师通过电子转诊至医院眼科服务（HES）的可行性、安全性和临床效果，与通过全科医生（GP）的传统纸质转诊进行对比。
三家验光机构通过 NHS Net 将连续转诊患者及其图像发送至 HES。标准的一般眼科服务表格经过电子重新设计，增加了患者对咨询、预约或手术的选择的相关信息。对研究期间之前同一三家验光机构的所有纸质转诊至 HES 的情况进行了分析（对照组 A），以及对法夫郡剩余的所有验光师的所有纸质转诊进行了分析（对照组 B）。
在 18 个月期间共收到 346 份电子转诊。其中 218 份（63%）被归类为需要进行 HES 预约，128 份（37%）不需要。后者随后进行了检查，发现了三例异常（青光眼、黄斑色素上皮脱离和可能的周边视网膜撕裂）。在两组中，报告的主要病理包括黄斑变性、白内障、青光眼、糖尿病视网膜病变和异常视网膜外观。A 组中共有 17 名（15%）患者和 B 组中共有 26 名（8.4%）患者被归类为不需要 HES 预约。这些对照组表明，约有 10-15%的纸质转诊在 HES 中未得到诊治。因此，总结来说，63%的通过电子转诊（有或无图像）直接由验光师转诊的人被安排了 HES 预约，而通过传统的纸质方法（无图像）通过 GP 转诊的人中有 85%被安排了 HES 预约。
电子转诊与 HES 的结合是安全、快速、高效和临床准确的，鉴于存在一些限制，避免了 37%的转诊中不必要的咨询。
