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PurposeThe patient journey from detection of an eye problem by optometrists to assessment and treatment by ophthalmologists can be streamlined by direct referral from optometrist to hospital eye service (HES). This requires locally agreed guidelines and training and feedback for optometrists to ensure high diagnostic competence. The purpose of this paper is to evaluate the quality of the West Suffolk Direct Referral Scheme, one of the first direct referral schemes in the UK to include all ophthalmic sub‐specialties.Design/methodology/approachTwo‐cycle audit of existing practice, including all new patients referred by optometrists and seen at West Suffolk Hospital during a three‐month period in 2003 and a seven‐week period in 2006. Three interventions: direct referral clinics for urgent patients; introduced in 2003; six‐monthly training sessions for optometrists; and regular, prompt feedback via letter about individual consultation outcome. Prospective data collection via proforma in both cycles; additional retrospective data collection in the second cycle. Diagnostic accuracy, perception of urgency and request of subspecialty clinic were evaluated.FindingsThe direct referral scheme streamlines the patient journey, and patients with acute problems have fast access to HES. In total, 99 per cent of referrals are appropriate. Diagnostic competence is high (87 per cent), and has improved with tighter communication between HES and optometrists. Agreement is less for referral urgency (75 per cent) and choice of subspecialty clinic (74 per cent).Originality/valueThe West Suffolk Direct Referral Scheme provides an efficient service of high quality. Good communications and continued feedback between community‐ and hospital‐based eye care services improve standards and facilitate efficient use of resources.

PurposeClient satisfaction is an important outcome measure of healthcare services. The aims of the present work are to develop a tool to assess client satisfaction with the components of streamlined cataract services and to conduct a pilot study to evaluate its reliability and validity.Design/methodology/approachA validated patient satisfaction questionnaire was modified for use in a cataract service and validated by expert panel and patient focus group approach. Two versions were used to evaluate pre‐operative assessment clinic and day surgical unit. The questionnaires comprised items covering individual domains of client satisfaction plus one global satisfaction item. Together with a visual analogue scale (VAS) the questionnaires were administered to 200 consecutive cataract patients.FindingsThe questionnaires were returned by 165 patients (82.5 per cent). Median individual item and global scores in the pre‐operative group were 87 and 100 per cent, respectively. In the day‐of‐surgery group median scores were 91 and 100 per cent, respectively. Mean VAS scores were 95.5 per cent (SD 5.6) and 94.5 per cent (SD 6.4), respectively. Cronbach's alpha was 0.768 for the pre‐operative and 0.636 for the day‐of‐surgery questionnaire. Spearman's correlation coefficient between individual item score and the VAS score was 0.350 (p=0.005) for the pre‐operative and 0.302 (p=0.028) for the day‐of‐surgery questionnaire. Spearman's correlation coefficient between individual item score and the global satisfaction score was 0.566 (pp=0.004) for the day‐of‐surgery questionnaire.Originality/valueThe questionnaire appears to be a useful tool for measuring client satisfaction with a one‐stop cataract pre‐assessment service where surgery is performed at a second visit, which other cataract service providers might adapt for local use.