General practice referral letters to a regional ophthalmic accident and emergency department

A significant proportion of patients seen in ophthalmic Accident and Emergency departments are referred by other medical practitioners. Two hundred and twenty-six referral letters from general practitioners to the Accident and Emergency Department of a large regional ophthalmology centre were examined. Information that was poorly recorded in the referral letters included social and personal background details, examination findings, management plans and investigation results. Analysis revealed that 50-70% of referrals did not constitute accidents or urgent conditions and could have been more properly assessed within usual secondary referral outpatient clinics. Ophthalmic Accident and Emergency is therefore providing a service for general practitioner referrals in excess of its defined function. The impact on purchaser/provider arrangements if appropriate redirection to outpatients were to occur would be significant.