Referral Best Practice
A high-quality referral answers a specific clinical question, conveys urgency accurately, and equips the receiving clinician to act without duplication. Patient-centred communication maintains trust and promotes adherence to the pathway.[1][2][3]
Selecting urgency and destination
- Same-day/urgent: suspected retinal tear/detachment, acute angle closure, microbial keratitis, CRAO/CRVO with acute loss, acute neuro-ophthalmic signs.[3][4][5][6]
- Soon/routine: visually significant cataract, glaucoma suspects per guideline thresholds, persistent ocular surface disease unresponsive to primary measures.[3][4]
Writing a clear, concise referral
State the question, working diagnosis, and reason for urgency.[3][1]
Include onset, laterality, VA, key positives/negatives, relevant systemic drugs (e.g., steroids, anticoagulants), and functional impact (driving, work).[3][6]
Attach images/fields where possible. [3][7]
Provide the patient with a plain-language explanation, practical next steps, and safety-net instructions.[2][1]
Closing the loop
Track referral acknowledgement, update records when outcomes return, and adjust local protocols if feedback identifies recurrent documentation gaps. It can help to audit a sample of referrals periodically for completeness and appropriateness.[7][1][3]
References (numbered in text)
- Standards of practice for optometrists and dispensing opticians — 7. Conduct appropriate assessments, examinations, treatments and referrals. General Optical Council Find (opens in a new tab)
- Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. NICE Clinical Guideline (CG138). National Institute for Health and Care Excellence Find (opens in a new tab)
- Referrals — Guidance for Professional Practice. The College of Optometrists Find (opens in a new tab)
- Management of Angle Closure Glaucoma: Guideline and evidence base. The Royal College of Ophthalmologists Find (opens in a new tab)
- Managing microbial keratitis. Royal College of Ophthalmologists Find (opens in a new tab)
- Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern (PPP) 2019. American Academy of Ophthalmology Find (opens in a new tab)
- Joint guidance on the NHS e-Referral Service. NHS England / NHS Digital Find (opens in a new tab)
References are included to demonstrate that all the content in this course is rigorously evidence-based, and has been prepared using trusted and authoritative sources.
They also serve as starting points for further reading and deeper exploration at your own pace.
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