articles

Go Back

Six top-tips for implementing PIFU

In recent years, there has been growing interest in Patient-Initiated Follow-up (PIFU) to manage outpatient demand. In 2018, a report by the Royal College of Physicians ‘Outpatients: The Future’, recommended PIFU as one of the ways in which to modernise outpatient care, and in particular allow “patients more control over when and how they receive care”. Indeed, the PIFU approach gives patients and their carers the opportunity to initiate their own follow-up appointments as and when the patient needs them, thus enabling self-management and shared decision-making. In practice, routine appointments for eligible patients (which can be inconvenient, stressful and an unnecessary expense) are replaced with on-demand appointments driven by symptoms or complications.

With an increasing number of outpatient appointments year after year, we have seen a shift from PIFU simply being a recommendation. Rather, in recent NHS guidance, providers are now being explicitly asked to implement PIFU. Further, PIFU now forms a key part of the NHS Outpatients Transformation Programme and the NHS’ response to the Covid-19 pandemic. In ‘Implementing Phase 3 of the NHS Response to the Covid-19 Pandemic’ the NHS provided detailed implementation guidance on PIFU.

Targeted investment funds have been made available with providers asked to propose a “shortlist of targeted investments that can deliver in year and have a material impact” where the focus should be on “delivering the highest priority elective recovery reforms” “and/or” on “systems and providers facing the greatest challenges in restoring activities to pre-pandemic levels.”

Clearly, PIFU should be a key consideration in providers’ elective recovery strategy. Nevertheless, the implementation of PIFU can be complex, requiring careful selection of appropriate pathways and patients, a re-design of current processes, as well as engagement with broad range of stakeholders. But where it is successfully implemented, PIFU can bring a range of benefits to providers, clinicians, but most importantly to patients.

Why use PIFU?

For providers, PIFU helps to reduce the demand for routine follow-up appointments, and in turn helps to manage service waiting lists. Evidence has shown that approximately 80% of patients on a PIFU pathway do not call back for an appointment that they would have routinely received. This is important when we consider that in 2019-20 there were 125 million outpatient appointments in England, a 66.9% increase from 10 years ago. This huge demand for outpatient services has created long waiting lists, with an estimated record high of 7.5 million waiting for hospital treatment in May 2023.

Where outpatient appointments are scheduled, Did Not Attends (DNAs) are a pertinent issue with an estimated 1 in 5 appointments resulting in DNAs. By allowing patients to take ownership of arranging their follow-up appointments, PIFU can also help to reduce DNA.

Alongside empowering patients, the benefits of PIFU for patients can also include a reduction in unnecessary visits to the hospital and the associated burdens including, needing to arrange childcare, taking time off work, and travel.

For clinicians, PIFU can release time to dedicate to more complex patients and those waiting for their initial appointments, as well as allow the clinician and patient to jointly develop the patient’s clinical plan.

Successfully Implementing PIFU: Six Top Tips

Given the intricacies that need to be considered within each patient pathway, successfully implementing a safe and sustainable PIFU model requires robust project management and clinical engagement from the offset.

Here is a summary of some of the key elements of our step–by–step implementation plan and top tips for a successful launch.

1. Engage – Host engagement sessions with clinical teams from the offset to agree on appropriate PIFU pathways and patient inclusion/exclusion criteria. Set up regular touchpoints with the clinical teams and operational managers to keep them up to date with progress throughout and to ensure they are fully signed up for key decisions. Other key stakeholders to engage with include patients, booking teams, IT teams and primary care.
2. Agree on the approach – Standardising the approach to implementation is crucial to ensure consistency across the organisation. A multidisciplinary Task & Finish group can provide a forum for agreeing on key steps of the implementation such as roles and responsibilities, comms material, booking rules, contact method for patients, outcoming considerations and reporting metrics and methods. Moreover, it can provide oversight and scrutiny to the implementation process and ensures risks and issues are escalated and dealt with, reducing blockers within the system and saving time. But don’t forget to allow the flexibility for individual pathways to be tailored to meet the clinical needs of each patient group – 1:1’s with the speciality leads will also be critical to the long-term success of and buy-in to the new PIFU pathways.
3. Pilot the process – Have in place pre and post-go-live checklists to support the launch of the new pathways. This helps ensure that all key requirements are met before the pathways go live. It is recommended that you go live with a few pathways initially to gain a better understanding of what is working well and what is not before any wider roll-out. And don’t forget to report the outcomes!
4. Measure success – Ensure you document baseline performance metrics so that you can evidence the significance of the change implementing PIFU has made over time.
5. Digitisation – If it is not already on the agenda, a long-term digital solution to support the PIFU process is highly recommended. Make the process more efficient with a patient portal which can host patient information, as well as allow patients to book appointments, and perhaps monitor long-term conditions by recording symptoms. Digitalisation will streamline the process and reduce the burden on clinical and support teams.
6. Extend PIFU to Follow-Up Backlogs – Identifying and moving existing backlog patients to PIFU can free up much-needed capacity. Carrying out an administrative search of letters on the Patient Administration System (PAS) can provide a subset of targeted patients for clinical triage to determine the patients suitable for the PIFU pathways.

How Four Eyes Insight can Support

As providers continue to work toward elective recovery and the implementation of PIFU, Four Eyes Insight is here to help.

We’ve already helped a number of Trusts and Health Boards set up their PIFU pathways, with some impressive results, including:

✔️ 34 against a target of 28 SOS/PIFU pathways rolled out
✔️ 80% anticipated saving of at least 4,510 follow-up appointments
✔️ 1608 patients on the waiting list had undergone administrative triage and were awaiting clinical sign-off as suitable for SOS/PIFU at project close
✔️ 851 suitable SOS/PIFU patients added to the follow-up waiting list

We use the combined power of people, data and technology to get to the root cause of NHS elective care pathway inefficiencies; working collaboratively and engaging with all stakeholders to get buy-in for change from the ground up. We implement interventions that optimise elective care pathways and provide tools to monitor their effectiveness ensuring that a culture of continuous improvement to drive long-term, sustainable change is embedded along the way.

If you would like to find out more or discuss your requirements, please email info@foureyesinsight.com