An audit of primary care referrals to the Ophthalmic Accident and Emergency Department of the Royal Victoria Eye and Ear Hospital, Dublin.

Aims: The objective of this audit was to determine the pattern of general practitioner referrals to the ophthalmic casualty department and to make recommendations to improve the service.

Methods: Clinical data were collected from the Accident and Emergency Department (A&E) case notes regarding patient demographics, reason for referral by GP, triage group, diagnosis and course of management.

Results: A total of 2,015 patients attended the A&E during the one-month study period, of whom 335 (16.6%) were GP referred. A total of 271 (80.9%) of these patients were non-urgent referrals. Non-painful and non-sight threatening conditions accounted for 172 (51.3%) referrals. The consistency of ocular examinations in the GP letters was poor, with only 16.4% recording visual acuity and 49.9% recording any examination findings.

Conclusion: There is a high rate of non-emergency referrals to the ophthalmic A&E. There is a need for better ophthalmic training for GPs, either as part of the existing training scheme or as part of continued education programmes. The introduction of a standard GP referral form with focused questions would allow better triage of these patients on arrival in the A&E department. The expansion of the role of the casualty nurse specialist would also help to alleviate pressure on this overburdened system.