Rejecting referrals - Imaging
Introduction
There are a number of reasons why you may wish to reject referrals back to optometrists, this topic covers images. It is important that providers are aware that:
a) It is impossible for us to verify that the images presented are of the patient described – providers should use both clinical judgement in assessing images and compare these to the patient when the they present
b) That the GOC is required to provide the date the image was taken
c) That before rejecting for image quality providers should:
- View the image in the PACS system prior to rejection to ensure that any quality issues are not related to the PDF production process
- Read any previous rejection letters to see if this is the best image that can be achieved – for example in Special Care patients, it may be impossible to acquire a high quality view
- Understand local arrangements – if a practice does not have an OCT facility and there are none available locally there is little advantage to patient care to reject a referral asking for an OCT
*Please ensure that you have read the referral guidelines for GOCs in your area – this will enable you to understand the requirements that have been agreed by the commissioners and avoid unnecessary rejections.
Please also remember that you can request an image from any English or Welsh hospital via the system – so if a practice reports that an image is available at a hospital please consider raising an IEP request for the image. IEP requests will generally take around 2 days to action and will automatically be added to the patients referral record.
Common issues with images
Depending on the nature of the referral and the area you work in, your referral may not have been triaged prior to this being received by you – especially if you are an EED provider. Where clinical triage systems are in place, our triagers will normally reject images that are not appropriate.
No images
This is the commonest reason for rejections of referrals. Please ensure that you have read the referral in case there has been adequate justification provided why an image has not been provided. In your rejection note please be clear on the type of image that you require.
Non diagnostic quality
Another common reason to reject a referral is for non diagnostic value of an image. Please read any comments from the referring optometrist. If an image is suitable for patient assessment (triage) but not treatment purposes you may prefer to accept the patient and take your own imaging.
Wrong image type
The most frequent reason for this rejection is the provision of single OCT views rather than multi-slice imaging. Please be aware that some optometry systems will produce a PDF only and hence they may be unable to upload a full OCT.
Adding comments
When rejecting for image issues you should add comments to the rejection letter explaining what the issue is and how it can be resolved, for example a better quality scan, different image type or a new image.
Last reviewed 05/01/2023