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Purpose : To create a standardized checklist for all glaucoma referrals to Hospital Sultanah Bahiyah by doing a survey with glaucoma specialists and to assess the quality of glaucoma referral letters received by a tertiary glaucoma unit before and after the implementation of the quality improvement intervention.
Methods : A survey on five glaucoma specialists on the information they deemed important to be included in the referral letter was done via e-mail correspondence. A retrospective review of all new glaucoma referral letters sent to the Glaucoma Clinic in Hospital Sultanah Bahiyah was done. Universal sampling method was used. Then, a prospective study was done for re-audit purpose after quality improvement plan.
Results : The survey revealed that the top 10 most desired information including patient’s name, identification-card number, date and reason(s) of referral, baseline intraocular pressure (IOP), trend of IOP on treatment, visual fields, current glaucoma therapy, any other ocular pathology, previous ocular surgery or laser treatment.
During audit period. 32.7% of letters achieved the yardstick of at least 8 out of 10 criteria. Only one referral letter included all desired information. Medical officers were generally better than ophthalmologists in providing the crucial information.
During re-audit period, minor improvement was observed. 3 glaucoma referral letters had fulfilled all desired information. 32.7% of letters achieved the yardstick, which was like the pre-intervention result.
Overall, while the intervention did not achieve desired target of 100%, there was an increase in the numbers of the desired criteria included in each referral letter.
Conclusion : Our audit highlights the need for improvement in glaucoma referral letters in view of most referral letters reviewed were of poor quality. A change of practice should be encouraged using glaucoma referral letter checklist, with emphasis on that important information which should not be missed when writing a comprehensive referral letter.
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