Access to ophthalmology assessment

When you are referred to a specialist eye doctor, you will usually be given the next available appointment. However, some clinicians or health services may use the information in your referral to decide when you receive an appointment. This means that people with more urgent needs may be seen more quickly. If you are referred to a health service or specialist eye doctor using this type of system, they will check the information in your referral to decide when you will receive an appointment. If key information is missing from your referral, they will ask you or the referring clinician to provide the missing details. If you are not ready for surgery, an optometrist may be able to suggest ways for you to manage your eye problems.

If your eyesight worsens or other circumstances change while you are waiting for an appointment, get in contact with the clinician who referred you and let them know.

Use an agreed local protocol to allocate appointments for referred patients, prioritising them according to clinical need, including social and cultural circumstances and barriers to accessing care. This is particularly important if there are waiting times for the first specialist assessment.

Assessment of clinical need includes both visual impairment and resulting limitations in vision-related activities. Social factors, including the impact of poor vision on the person’s ability to work and live independently, should also be considered.

If the referral is incomplete, the referring clinician should be prompted for further information. The assessment should be scheduled in a time frame that is consistent with agreed health service protocols to ensure that patients are assessed in a timely way.

Referrals should be reviewed by a credentialed ophthalmic clinician who can use the information in the referral to make an initial assessment about the appropriateness of referral, severity of symptoms and relative priority for ophthalmological assessment. Use of standardised criteria and tools allows consistency of assessment, and assists when prioritising patients within a health service or system.^27,31

When patients are referred for consideration for cataract surgery, appointments are allocated using protocols that prioritise patients based on clinical need, including social circumstances, based on adequate information about the referred patient. This is particularly important in health service organisations that have substantial waiting lists for the first specialist assessment.

These protocols should describe criteria for accepting referrals and prioritising patients for ophthalmology assessment. They should include any tools to be used for providing standardised information, and allow for a credentialed ophthalmic clinician to review referrals to determine the priority and timing of ophthalmology assessments. In some states and territories, these protocols may be determined at a health department level for public hospital clinics.

Where referral criteria apply, these should be readily available and communicated to referring clinicians and patients. Consider providing a standardised referral template for referrals from the community to help ensure that adequate information is provided.

Protocols should include pathways for patients who do not meet referral criteria, who choose non-surgical options, or for whom surgery is considered unsuitable or inappropriate at ophthalmologic assessment. These pathways may include reassessment or follow-up, or referral to other services such as optometry, orthoptist, occupational therapy or vision clinics. Provide information back to the referring clinician.

Processes should be in place to monitor patients waiting for first ophthalmology appointments in case their clinical needs and priority change.

Monitor and audit outcomes within a quality improvement framework to assess whether desired outcomes are being achieved, including the time frame from referral to assessment and surgery.