Glaucoma was the third most common issue that resulted in a risk of sight loss or blindness in Scotland in 2015 and accounts for 20% of referrals from primary to secondary care. With an ageing population, those referral numbers were expected to increase.
Against that background, we produced a guideline for glaucoma referral and safe discharge in 2015. Two aims for this guideline were: to improve the accuracy of referrals of patients with suspected glaucoma from community to secondary-eye-care service, and to decrease false positive referrals to secondary-eye-care services.
Production of the guideline is in itself crucial, but just as important to the staff and clinicians who developed the guideline was to ensure that the guideline was effective, that it was used and that it made a real difference to the care that people received.
To better understand this, we looked at what had happened since the guideline was published.
Getting the message out
What we found was that over 66,800 copies of the guideline had been downloaded or distributed in the 21 months since publication. The guidelines were requested by services all over Scotland, including hospital out-patient departments, GP practices, high street optometrists, and specialist organisations such as NHS Education for Scotland and Optometry Scotland.
“Production of the guideline is in itself crucial, but just as important to the staff and clinicians who developed the guideline was to ensure that the guideline was effective, that it was used and that it made a real difference to the care that people received.”
In the guideline we outlined several suggestions that would support the implementation of it, including training and auditing of key points. The year after the guideline was published NHS Education for Scotland ran 15 training courses in 13 locations addressing the training needs identified in the guideline – 294 community optometrists attended the training events. We found that at least three secondary-eye-care services had undertaken audits relevant to the guideline. We also co-facilitated a workshop at the 2017 NES Annual Optometry Conference, focussed on the guideline and its impact.
The impact it made
Most importantly, we learned from all this work that accuracy of referrals from community optometrists had improved and that rates of false positive referrals from community optometrists have decreased since the introduction of the guideline. In addition, community optometrists reported an increased measurement and reporting of recommended parameters to ensure more accurate diagnosis, as well as reporting an increased confidence in their decision making and patient management.
Using knowledge to make improvements
Working to ensure that the right people make use of our guidelines is always a work in progress.
We found that better communication could lead to further success. For example, we found out via a survey that 92% of respondents reported they had had no communication with their local secondary care clinic.
It is clear that some aspects of the guideline have been implemented more universally than others –it’s possible that additional targeted training and education on the implementation of the guideline could lead to further improvements in referral accuracy and patient care, which would be welcomed by the optometry profession, and the wider eye care community.
“We learned from all this work that accuracy of referrals from community optometrists had improved and that rates of false positive referrals from community optometrists have decreased since the introduction of the guideline.”
Overall, the guideline appears to have been accepted as a positive move by the optometry profession, and has had a positive impact on patient care, and I know that SIGN look forward to taking this learning forward into the development of other guidelines.
Lisa Cowan is Senior Postgraduate Optometry Tutor with NES and co-author of ‘The impact of a SIGN guideline: SIGN 144 Glaucoma referral and safe discharge.
To access the full guideline and impact report, visit the SIGN website.