Skip to main content

Advertisement

SpringerLink
Log in

Impact of an email advice service on filtering and refining ophthalmology referrals in England

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The growing capacity–demand imbalance has necessitated the accelerated digital transformation of eye care services. The role of Oxford Eye Hospital’s (OEH) email advice service has become even more relevant in the post-Covid era. We sought to evaluate its impact on referrals to secondary care.

Methods

The consultant-led OEH email advice service primarily targets primary eye care personnel (optometrists and GPs) requiring clinical advice on patient referral. Emails received between September and November 2020 were analysed for demographic data, contents, characteristics, and outcomes. Thematic analysis was performed. A user feedback survey was conducted.

Results

A total of 828 emails were received over the 3-month study period (mean 9.1/day). They were predominantly from optometrists (77.9%) and general practitioners (16.1%). Of the 81.0% (671) relating to clinical advice, over half (54.8%) included images from a variety of modalities, and following review, over half (55.5%) were deemed suitable for management in the community, while 36.5% were referred directly to appropriate subspecialty clinics. Only 8.1% required urgent assessment in eye casualty. Thematic analysis showed that this service was most useful for retinal lesions, optical coherence tomography abnormalities, and borderline abnormal optic discs. No adverse events were identified. User feedback was very positive.

Conclusion

A secure email advice service is a safe and low-maintenance modality that provides direct and efficient two-way communication between primary and secondary eye care professionals. It allows rapid response to clinical queries, referral filtering and refinement, and streamlining of patient referral pathways. Users (predominantly optometrists) were overwhelmingly positive about its usefulness in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. RCOphth. The way forward: executive summary [Internet]. [cited 2023 Feb 19]. https://www.rcophth.ac.uk/wp-content/uploads/2021/12/RCOphth-The-Way-Forward-Executive-Summary-300117.pdf

  2. Kang S, Raja L, Sim DA, Thomas PBM, Ezra DG (2021) Telemedicine in oculoplastic and adnexal surgery: clinicians’ perspectives in the UK. Br J Ophthalmol

  3. Li JPO, Thomas AAP, Kilduff CLS, Logeswaran A, Ramessur R, Jaselsky A et al (2021) Safety of video-based telemedicine compared to in-person triage in emergency ophthalmology during COVID-19. EClinicalMedicine 34:100818

  4. Li JPO, Liu H, Ting DSJ, Jeon S, Chan RVP, Kim JE et al (2021) Digital technology, tele-medicine and artificial intelligence in ophthalmology: a global perspective. Prog Retin Eye Res 82:100900

  5. Montgomery-Taylor S, Cotton R, Manek N, Watson M, Klaber RE (2015) Using an email advice line to connect care for children. Arch Dis Child 100(6):600–601

    Article  PubMed  Google Scholar 

  6. Fulton AL, Williams HR, Shah J, Phillips L, Fluxman J, Hoare JM (2016) Specialist advice for primary care: an evaluation of a gastroenterology email advice service. Future Hosp J 3(2):90–93

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cameron JR, Ahmed S, Curry P, Forrest G, Sanders R (2009) Impact of direct electronic optometric referral with ocular imaging to a hospital eye service. Eye Lond Engl 23(5):1134–1140

    CAS  Google Scholar 

  8. Jeganathan VSE, Hall HN, Sanders R (2017) Electronic referrals and digital imaging systems in ophthalmology: a global perspective. Asia Pac J Ophthalmol Phila Pa 6(1):3–7

    Google Scholar 

  9. Mole G. Secure communication between primary and secondary care for urgent advice and guidance [Internet]. NHSX. [cited 2021 May 13]. https://www.nhsx.nhs.uk/key-tools-and-info/digital-playbooks/eye-care-digital-playbook/secure-communication-between-primary-and-secondary-care-for-urgent-advice-and-guidance/

  10. The Royal College of Ophthalmologists, The College of Optometrists. Ophthalmology and Optometry: Our vision for safe and sustainable patient eye care services in the UK

  11. Konstantakopoulou E, Edgar DF, Harper RA, Baker H, Sutton M, Janikoun S et al (2016) Evaluation of a minor eye conditions scheme delivered by community optometrists. BMJ Open 6(8):e011832

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Baker H, Ratnarajan G, Harper RA, Edgar DF, Lawrenson JG (2016) Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt 36(5):545–557

    Article  PubMed  Google Scholar 

  13. Learoyd AE, Tufail A, Bunce C, Keane PA, Kernohan A, Robinson E et al (2021) FENETRE study: quality-assured follow-up of quiescent neovascular age-related macular degeneration by non-medical practitioners: study protocol and statistical analysis plan for a randomised controlled trial. BMJ Open 11(5):e049411

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sampson R, Barbour R, Wilson P (2016) The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study. BMC Fam Pract 14(17):45

    Article  Google Scholar 

  15. The Royal College of Ophthalmologists. Sharing patient information between healthcare professionals—a joint statement from The Royal College of Ophthalmologists and College of Optometrists [Internet]. The Royal College of Ophthalmologists. 2015 [cited 2023 Jun 10]. https://curriculum.rcophth.ac.uk/2015/03/sharing-patient-information-between-healthcare-professionals-a-joint-statement-from-the-royal-college-of-ophthalmologists-and-college-of-optometrists/

  16. Evans BJW, Edgar DF, Jessa Z, Yammouni R, Campbell P, Soteri K et al (2021) Referrals from community optometrists to the hospital eye service in England. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom 41(2):365–377

    Article  Google Scholar 

  17. Harvey K, Edgar DF, Agarwal R, Benwell MJ, Evans BJ (2022) Referrals from community optometrists in England and their replies: a mixed methods study. Ophthalmic Physiol Opt J Br Coll Ophthalmic Opt Optom 42(3):454–470

    Article  Google Scholar 

  18. Brown K, Sewell JM, Trempe C, Peto T, Travison TG (2013) Comparison of image-assisted versus traditional fundus examination. Eye Brain 5:1–8

    Article  PubMed  PubMed Central  Google Scholar 

  19. Balaskas K, Gray J, Blows P, Rajai A, Flaye D, Peto T et al (2016) Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model. Br J Ophthalmol 100(5):665–670

    Article  PubMed  Google Scholar 

  20. Chojniak R (2015) Incidentalomas: managing risks. Radiol Bras 48(4):9–10

    Article  Google Scholar 

  21. Hitzeman N, Cotton E (2014) Incidentalomas: initial management. Am Fam Physician 90(11):784–789

    PubMed  Google Scholar 

  22. Roelofs KA, O’Day R, Al Harby L, Arora AK, Cohen VML, Sagoo MS et al (2020) The MOLES system for planning management of melanocytic choroidal tumors: Is it safe? Cancers (Basel) 12(5):1311

  23. Harby LA, Sagoo MS, O’Day R, Hay G, Arora AK, Keane PA et al (2021) Distinguishing choroidal nevi from melanomas using the MOLES algorithm: evaluation in an ocular nevus clinic. Ocul Oncol Pathol 15:1–9

    Google Scholar 

  24. Poostchi A, Awad M, Wilde C, Dineen RA, Gruener AM (2018) Spike in neuroimaging requests following the conviction of the optometrist Honey Rose. Eye 32(3):489–490

    Article  CAS  PubMed  Google Scholar 

  25. Blanch RJ, Horsburgh J, Creavin A, Burdon MA, Williams C (2019) Detection of Papilloedema Study (DOPS): rates of false positive papilloedema in the community. Eye 33(7):1073–1080

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kovarik JJ, Doshi PN, Collinge JE, Plager DA (2015) Outcome of pediatric patients referred for papilledema. J AAPOS Off Publ Am Assoc Pediatr Ophthalmol Strabismus 19(4):344–348

    Google Scholar 

  27. NHS. Chapter 5: Digitally-enabled care will go mainstream across the NHS [Internet]. NHS Long Term Plan. [cited 2021 May 13]. https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/

  28. NHS England. Digital playbooks [Internet]. NHS Transformation Directorate. [cited 2023 Jun 10]. https://transform.england.nhs.uk/key-tools-and-info/digital-playbooks/

  29. Han JED, Liu X, Bunce C, Douiri A, Vale L, Blandford A et al (2022) Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study—HERMES study report 1—study protocol. BMJ Open 12(2):e055845

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kern C, Fu DJ, Kortuem K, Huemer J, Barker D, Davis A et al (2020) Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care. Br J Ophthalmol 104(3):312–317

    Article  PubMed  Google Scholar 

  31. Sampson R, Barbour R, Wilson P (2016) Email communication at the medical primary-secondary care interface: a qualitative exploration. Br J Gen Pract J R Coll Gen Pract 66(648):e467-473

    Article  Google Scholar 

  32. Pannell LM, Tyrrell-Price J (2017) Communication between primary and secondary care. Br J Hosp Med Lond Engl. 78(8):464–466

    Article  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK

    Ariel Yuhan Ong, Aoife Naughton, Stella Hornby & Audrey Shwe-Tin

Authors
  1. Ariel Yuhan Ong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aoife Naughton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stella Hornby
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Audrey Shwe-Tin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AYO contributed to conceptualization, methodology, analysis, investigation, writing—original draft, review, editing, and visualization. AN contributed to methodology, analysis, investigation, and writing—review, editing. SH contributed to methodology, resources, writing—review, editing, and supervision. AS-T contributed to conceptualization, methodology, resources, writing—review, editing, and supervision.

Corresponding author

Correspondence to Ariel Yuhan Ong.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ong, A.Y., Naughton, A., Hornby, S. et al. Impact of an email advice service on filtering and refining ophthalmology referrals in England. Int Ophthalmol 43, 4019–4025 (2023). https://doi.org/10.1007/s10792-023-02806-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-023-02806-y

Keywords

Search

Navigation