Audit of Referrals to an Ophthalmic Outpatient Clinic of a Tertiary Eye Care Centre in a Developing Country

Abstract

Objectives: To determine the referral pattern and assess the quality and accuracy of referral letters to the ophthalmic outpatient clinic of University of Nigeria Teaching Hospital, Enugu.
Methods: This study is a prospective cross-sectional survey of all new ophthalmic referrals to the ophthalmic outpatient clinic at University of Nigeria Teaching Hospital, Enugu between 1st July 2006 and 31st December 2006. Patients’ referral letters and clinical case notes
provided information on demography, referral source, referral diagnosis, definitive diagnosis and quality of referral letter. The number of ophthalmic outpatient consultations during the study period was obtained from
clinic records. Data were analysed with the Statistical Package for Social Sciences to generate frequency and percentage distributions. The chi-square test was used for inter-group comparison at p< 0.05.
Results: There were 461 new ophthalmic referrals comprising 217 (47.1%) males and 244 (52.9%) females. The rate of referrals based on gender was not significant (p=0.3044). The age range was 3-67 years (mean=18.5 years, SD=0.6). More adults (> 16 years) than children (< 16 years) were referred (p<0.05). New referrals constituted 18.2% of the 2,531 ophthalmic outpatient consultations. After definitive diagnosis, refractive error (19.9%) and allergic conjunctivitis (17.4%) were the main ocular diseases leading to referral. Fifty-two percent of referral letters
satisfied the provision of clinical information criteria, 2.8% satisfied the formulation of specific request criteria, while 1.9% satisfied both. Ophthalmologist-initiated referrals were most accurate (78.6%), while referrals from paediatricians were the least accurate (13.9%). The majority of patients 256 (55.7%) were referred by GPs while ophthalmologists referred the minority-14 (3.0%). Conclusions: The majority of the referral letters were of poor quality, low accuracy, and inappropriate. To reverse this
trend, local educational interventions which incorporate clinical correspondence into undergraduate medical training curriculum, and the organization of workshops on clinical information exchange for GPs, specialists and paramedical personnel are recommended.

Key words: audit, referrals, ophthalmic outpatient, Enugu, Nigeria