Institute of Optometry, London, UK.
Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK.
Ophthalmic Physiol Opt. 2021 Mar;41(2):365-377. doi: 10.1111/opo.12772. Epub 2020 Dec 22.
In the UK, most referrals to the hospital eye service (HES) originate from community optometrists (CO). This audit investigates the quality of referrals, replies, and communication between CO and the HES.
Optometric referrals and replies were extracted from three practices in England. If no reply letter was found, the records were searched at each local HES unit, and additional replies or records copied. De-identified referrals, replies and records were audited by a panel against established standards to evaluate whether the referrals were necessary, accurate and directed to the appropriate professional. The referral rate (RR) and referral reply rate (RRR) were calculated.
A total of 459 de-identified referrals were extracted. The RR ranged from 3.6%-8.7%. The proportion of referred patients who were seen in the HES unit was 63%-76%. From the CO perspective, the proportion of referrals for which they received replies ranged from 26%-49%. Adjusting the number of referrals for cases when it would be reasonable to expect an HES reply, RRR becomes 38%-62%. Patients received a copy of the reply in 3%-21% of cases. Referrals were made to the appropriate service in over 95% of cases, were judged necessary in 93%-97% and were accurate in 81%-98% of cases. The referral reply addressed the reason for the referral in 93%-97% and was meaningful in 94%-99% of cases. The most common conditions referred were glaucoma, cataract, anterior segment lesions, and neurological/ocular motor anomalies. The CO/HES dyad (pairing) in the area with the lowest average household income had the highest RR.
In contrast with the Royal College of Ophthalmologists/College of Optometrists joint statement on sharing patient information, CO referrals often do not elicit a reply to the referring CO. Replies from the HES to COs are important for patient care, benefitting patients and clinicians, and minimising unnecessary HES appointments.
在英国，大多数转介至医院眼科服务（HES）的病例都来自社区视光师（CO）。本审计调查了 CO 与 HES 之间的转介质量、回复和沟通情况。
从英格兰的三家诊所中提取视光师的转介和回复。如果未找到回复函，则在每个当地 HES 单位中搜索记录，并复制其他回复或记录。由一个小组按照既定标准审核去识别的转介、回复和记录，以评估转介是否必要、准确且指向合适的专业人员。计算转介率（RR）和转介回复率（RRR）。
共提取了 459 份去识别的转介。RR 范围为 3.6%-8.7%。在 HES 单位就诊的转介患者比例为 63%-76%。从 CO 的角度来看，他们收到回复的转介比例为 26%-49%。调整 HES 合理回复预期病例的转介数量后，RRR 变为 38%-62%。在 3%-21%的情况下，患者收到了回复的副本。超过 95%的转介都指向了合适的服务，93%-97%的转介被认为是必要的，81%-98%的转介是准确的。转介回复在 93%-97%的情况下都涉及转介原因，在 94%-99%的情况下都具有意义。最常见的转介情况是青光眼、白内障、前段病变和神经/眼运动异常。在平均家庭收入最低的地区，CO/HES 对偶（配对）的 RR 最高。
与皇家眼科医师学院/视光师学院关于共享患者信息的联合声明相反，CO 的转介往往不会引起对转介 CO 的回复。HES 对 CO 的回复对患者护理很重要，使患者和临床医生受益，并最大限度地减少不必要的 HES 预约。
