Safe Escalation and Referral

When limits are reached, safe escalation ensures patients still receive appropriate care. Referral should be timely, transparent, and proportionate to clinical risk.^[1][4][2]

Principles of safe escalation

Best practice is to:

• Explain findings to the patient in plain language and outline why referral is necessary.^[5][2]
• Match urgency to the level of clinical risk.^[3][4]
• Provide clear written referrals that include symptoms, clinical findings, and patient concerns.^[2]
• Offer reassurance that referral is a safety measure rather than a reflection of inadequate care.^[5]
• Document the discussion to support accountability and continuity.^[2][5]

Timely referral can save lives.^[4][6]

References (numbered in text) Why we include references

1. 6. Recognise, and work within, your limits of competence — Standards of practice for optometrists and dispensing opticians. General Optical Council. Find (opens in a new tab)
2. Referrals — Communication, partnership and teamwork. The College of Optometrists. Find (opens in a new tab)
3. Annex 4: Urgency of referrals table. The College of Optometrists. Find (opens in a new tab)
4. Managing acute physical deterioration through the 'prevention, identification, escalation, response' (PIER) approach. NHS England. Find (opens in a new tab)
5. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. NICE Clinical Guideline CG138. Published: 24 February 2012; Last updated: 17 June 2021. National Institute for Health and Care Excellence. Find (opens in a new tab)
6. Assessment of delays in presentation of patients with retinal detachment to a tertiary referral centre. Shauna M Quinn; Farhan Qureshi; Stephen J Charles. Ophthalmic and Physiological Optics. 2004. Find (opens in a new tab)