Objective: To determine the accuracy, quality and timing of ophthalmic referrals.
Design: This was a prospective study. The data was collected using a pro forma. All patients gave voluntary written consent.
Setting: The Ophthalmology Division at the University Hospital of the West Indies
Participants: All new patients referred to the Ophthalmology Division from August 3, to November 3, 2016. It excluded patients referred for disease screening.
Result: There were 207 patients recruited, 114 (55%) males and 93 (45%) females, aged four months – 87 years (Mean age 45.4years, SD 20.8). The majority were from general practitioners (33%), followed by ophthalmologists (28%) and emergency physicians (23%). The most common conditions were glaucoma (12%), cataract (10%) and uveitis (10%). Only 20% of referrals contained all four referral elements - history, examination, visual acuity and diagnosis. Ophthalmologist referrals were most accurate (89%), while general practitioners (29%) were least accurate. Mean time from referral to the patient presenting to the eye clinic and being seen was 82 days for routine and 4.2 days for emergent/urgent referrals. There were 41 adverse events (19.8%); delays due to physician factors (inappropriately written referrals, inappropriate medications used or lack of disease screening) or patient factors including prolonged time to presentation.
Conclusion: There is a high-rate of poorly written referrals and inaccurate diagnoses. Inadequate communication, poor timing of referrals, inaccurate diagnosis and treatment affect patient outcomes. With standardized referrals, patient morbidity may be reduced.
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