Standardizing the Referral Letter to Improve Care

Brianne N. Hobbs, OD


April 14, 2014

In This Article

Study Summary

A study published in Ophthalmology by Cheng and colleagues addressed the quality of referral letters from optometrists and general ophthalmologists to glaucoma specialists. Members of the Canadian Glaucoma Society and the American Glaucoma Society were surveyed about essential components of referral letters. One purpose of this study was to identify the information deemed necessary by glaucoma specialists for the diagnosis of glaucoma. Respondents were also asked to pinpoint the key information for assessing the presence of glaucomatous progression. A secondary purpose was to assess the quality of letters received by glaucoma specialists and to identify the most common errors.

Regarding the diagnosis of glaucoma, specialists responded that they would most like to receive the following information for a patient (percentage of respondents):

Maximum intraocular pressure (IOP; 75%)

Current/recent IOP (64%)

Disc evaluation (64%)

Serial visual fields (VFs; 58%)

Recent VFs (46%)

This list differed slightly from the information a specialist would ideally like to receive about a patient regarding glaucomatous progression:

Serial VFs (81%)

Current glaucoma therapy (63%)

Current/recent IOP (63%)

Maximum IOP (51%)

Serial disc imaging (43%)

Upon analysis of the referral letters, it was apparent that most did not contain the desired information, specifically serial VFs, maximum IOP, and serial disc imaging. The absence of this information may represent miscommunication or a lack of communication between the referring doctor and specialist regarding the exam elements that should be included in the referral. Most respondents preferred that the urgency of the patient's referral be included in the letter, but only 27% of letters actually contained this information.



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