Compliance of ophthalmology referrals (from endocrine wards) with outlined criteria in request forms

Aims: To investigate the completion of ophthalmology referral request forms from the Endocrine wards at Good Hope Hospital (GHH). There is no standardised visual acuity assessment equipment available on these wards, therefore it was unlikely that these request forms were being completed adequately. Appropriate completion of request forms is imperative for effective triage by the Ophthalmology team.

Methods: This was a closed-loop two cycle audit on compliance to the NHS Prescribing information and communication system (PICS) ophthalmology request forms for referrals from endocrine wards. There were no exclusion criteria. This was a retrospective analysis of all patients referred since the induction of the PICS referral system in April 2025. Before this, referrals were made via email. Therefore, this was a preliminary audit with a small data pool. The ‘Ward Referrals’ book from the Ophthalmology department was used to select patients from Endocrine wards. Then, data was collected on the completion of the PICS request forms. 

Following the first cycle, recommendations were:

·         Request forms must be completed appropriately by referring clinician

·         All endocrine wards must have Snellen charts, and all doctors trained in the use of them

·     Request forms should replace ‘Brief history and examination findings’ with: ‘Brief History’, ‘Details of eye disease’, ‘Eye examination findings’ to yield more relevant findings for Ophthalmologists taking referrals.

To implement these recommendations, these actions were taken:

1.      A detailing of the audit and the recommendations to resident doctors 

2.      Reminder posters with guidance on how to complete request forms appropriately

3.      Installation of Snellen charts on both Endocrine wards, with instructions on how to use them

4.      Recommendations to the Ophthalmology department regarding recommendations on changes to the request form. No correspondence was received from them regarding this.

Results: Cycle 1

·         6 total patients 

·         1 patient mistakenly referred via the old emailing system 

·         0% of patients referred with visual acuity assessed using a standardized eye chart

·         3/5 patients referred with BG/ investigations/clinical impression details (60%)

·         4/5 patients referred with admission details (80%)

·         1/5 patients referred with examination findings (20%)

·         1/5 referred with contact number (20%) 

Cycle 2

A second cycle was completed in November using data from request forms from August – November 2025 to close the loop. This cycle was to assess implementation of recommendations from the first cycle of the audit.

·         7 total patients

·         4/7 patients referred with acceptable answer for visual acuity (60%), but still 0% recording Snellen chart result

·         6/7 patients referred with BG details (86%)

·         6/7 patients referred with investigation details (86%)

·         3/7 patients referred with clinical impression (42%)

·         100% of patients referred with admission details

·         4/7 patients referred with examination findings (60%)

·         5/7 patients referred with a contact number (70%) 

Conclusion: Overall, there was a significant improvement in completion of request forms including:

·         42% increase in acceptable visual acuity result

·         Still 0% recording Snellen chart result

·     Significant improvement of completion of request forms, including 20% increase in completion of admission details, background and investigations. 

·         40% increase in completion of examination findings

·         50% increase in completion of contact details

·         Slight drop in completion of clinical impression by 20%