Impact of digital versus faxed e-referrals on triage decisions in a medical retina clinic

Clin Exp Optom. 2026 Mar 3:1-8. doi: 10.1080/08164622.2026.2636145. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Efficient triage is essential for managing increasing demand in resource-constrained ophthalmic services. Referral systems that enable structured clinical information and high-quality ocular imaging may support prioritisation according to clinical need and improve service efficiency.

BACKGROUND: This study compared triage decisions made using traditional faxed referrals to those made using digital referrals with high-resolution retinal imaging in an Australian public hospital medical retina outpatient clinic.

METHODS: Two ophthalmologists independently reviewed referrals for 100 patients (n = 73 for assessment of diabetic eye disease, n = 27 for other medical retina conditions). Referrals were originally generated by optometrists using a digital referral platform with colour fundus photographs and/or optical coherence tomography images and were transmitted to the hospital via fax (2018-2021). Study assessors were masked to original triage decisions and post-referral clinical findings. Each assessor graded the urgency of an appointment using the faxed version of the referral prior to assessing the corresponding digital referral file via a five-level triage classification system. Medical records were retrospectively reviewed to evaluate the alignment between triage decisions and downstream clinical outcomes.

RESULTS: At the time of original referral, 28% of patients were classified as requiring an appointment within a week, and 8% were deemed not to need an appointment. Agreement between assessors was moderate (exact match in triage level for 59.5% of cases across referral formats). Assessors were more likely to downgrade appointment urgency or reject referrals when grading digital files compared to when assessing the matched faxed referrals (45% downgraded urgency for Assessor 1, 13% Assessor 2).

CONCLUSIONS: Digital referrals with high-resolution imaging may improve triage accuracy in medical retina clinics by better aligning appointment urgency with clinical need. Greater alignment between referring optometrists and specialist services through interoperable systems, structured referral protocols, and secure image sharing may further enhance efficiency and communication across care settings.

PMID:41775269 | DOI:10.1080/08164622.2026.2636145