Mapping Greener HealthcareMapping Greener Healthcare

Project Description

Background: Ophthalmology services are increasing in demand. Appropriate referrals reduce burdens on the service and ensure patients with serious conditions are seen. The local clinical commissioning group (CCG) of Manchester Royal Hospital commissions a service to triage general practitioner (GP) referrals to secondary care, so patients who can be seen in other services are seen in secondary care rather than further burdening the ophthalmology services.

Approach: This project sought to investigate the quality of referrals to primary care/comprehensive ophthalmology. The main reason for referral was a decrease in vision. About two-thirds of referrals came from optometrists via GPs. Of GP referrals, approximately half went through the triaging gateway. Issues with referral standards included referral of patients for dry eyes without appropriate trial of lubricating eye drops, potentially acute conditions referred routinely rather than within 24 hours, and referrals to ophthalmology which could have been seen within other services.

Intended Benefits

Patient outcomes: By improving the referral system, patient outcomes could improve as well since referrals are made appropriately and reducing the burden on ophthalmology services. A particular issue is the routine referral of potentially acute conditions.

Environmental, Financial, Social: The project found that there needs to be further education and guidance on referring patients to outpatient ophthalmology. The triaging service is underutilised and subjective, so referral guidance provided directly to referrers might be beneficial. Through higher quality referrals, the environmental and financial impacts could be reduced as patients can be provided care from the appropriate service avoiding waste of resources.

Key Aspects of the Project

This audit allowed the hospital to understand how patient entry into care can be enhanced, improving patient outcomes and efficacy.