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Abstract: Importance: Referral letters constitute the first step on the pathway to cataract surgery; however, little is known on how effective referral letters are in providing adequate information to triage patients and inform surgical prioritization. Background: Benchmarking exercises are important to document referral processes and to identify areas where improvements can be made. Design: Cross‐sectional study with longitudinal follow‐up conducted at two metropolitan public hospitals in New South Wales, Australia. Participants: A total of 400 sequential cataract referral letters. Methods: An audit of cataract referral letters was performed and content benchmarked against international prioritization tools. Medical records were reviewed 1 year following referral. Main Outcome Measures: Referral quality and waiting times. Results: Two‐thirds of patients referred for cataract surgery were yet to have their initial hospital appointment in the year following referral (65%, 245/376). One half of referrals seen in clinic (49%, 64/113) were not listed for cataract surgery. Multivariate analysis revealed referral letter content was not indicative of surgical booking, with the major predictors being hospital‐recorded visual acuity and grading of cataract (P < 0.0001). Referral content lacked sufficient detail to apply prioritization tools developed in other settings. Conclusion and Relevance: This audit highlights a disconnect between referral letter content and hospital assessment of patients. Current referrals to public hospitals are poorly targeted, with high numbers of referred patients not proceeding to surgery. Patients commonly waited over 1 year to have their ophthalmic assessment at these public hospital eye clinics, revealing lengthy ‘wait‐for‐waits’ as a barrier to care. Standardized referral templates may facilitate improvement of referral pathways and shorten waiting times. [ABSTRACT FROM AUTHOR]

Objection: To analyse the patient, clinical and microbiological variables associated with poor outcomes from keratitis in patients presenting to a major public hospital in Australia. Methods: A retrospective audit of the records of all patients who had a corneal scraping in 5 years at Princess Alexandra Hospital (Brisbane, Australia) was carried out. The outcome of a patient's episode of keratitis was classified as poor if they had final visual acuity of 6/60 or worse; had vision loss during treatment; or a complication of keratitis; or needed surgical intervention. Results: A final outcome was established in 207 cases during the 5-year period. Final vision of 6/12 or better was found in 48% (100) of cases while a poor outcome was seen in 28% (58). Linear regression showed poor outcomes were directly associated with age ( P < 0.001) and disease severity ( P < 0.001). Univariate analysis indicated that poor outcomes were more likely in patients who had had prior ocular surgery ( P = 0.005) or ocular surface disease ( P = 0.01) and were also associated with presenting visual acuity of worse than 6/60 ( P < 0.001) and isolation of Streptococcus pneumoniae ( P = 0.002). While patients with traumatic keratitis, contact lens-related keratitis or negative corneal cultures ( P = 0.009) were more likely to have good outcomes. Multivariate analysis showed that the relative risk of a patient having a poor outcome was 4.3× (CI 2.0–9.5) if they had severe keratitis, 4.1× (CI 1.8–9.5) if they had keratitis related to ocular surface disease and 3.8× (CI 1.8–8.3) if they were over 50 years old. Conclusions: An outcome of poor vision, vision loss during treatment, surgical intervention or complication of keratitis is more likely in patients with severe keratitis, keratitis related to prior ocular surface disease or older age. [ABSTRACT FROM AUTHOR]