Managing patient risk: Why PIFU makes sense

NHS England’s Operational Planning Guidance has earmarked delivering Patient Initiated Follow-Up (PIFU) as a major change needed to reduce waiting lists, make hospital visits more efficient and to improve the patient experience.  

Up to two thirds of all hospital appointments are currently taken up with often unnecessary follow-up reviews. PIFU can be a game changer and make a real difference in tackling the waiting list backlog by freeing up appointment slots, amongst other challenges (did you know that approximately 5% of all road traffic is NHS-related?).

What is PIFU? 

In a nutshell, PIFU gives patients and their carers the flexibility to arrange their follow-up appointments as and when they need them. With appointment slots being at a premium, having so many taken up by unnecessary follow-up reviews doesn’t make sense.

Those on a PIFU pathway can request a follow-up appointment based on their needs, rather than it being automatically allocated for them.  

Changing to this needs-based system would bring about two key benefits of PIFU: 

1. Free up more appointments slots for those who really need them
2. Reduce the time hospital staff spends on admin so they can focus on patients

However, there are questions that needs to be answered. If there are less follow-up appointments scheduled, how do we ensure all patients are receiving the care they need?  

With annual winter pressures of capacity and an already tired front-line staff, can targets set in the Elective Recovery plan be achieved? How do Trusts even get started implementing PIFU? 

Delivering the benefits of PIFU 

While any form of PIFU can deliver the benefits mentioned above, many Trusts start with admin-heavy spreadsheets or using non-integrated lists that sit outside their regular systems.  

This limits the benefits of PIFU as information between the lists and hospital systems can be out of sync meaning lack of clarity about available slots. It also doesn’t deliver the admin reduction needed as staff spend time making sure each system is up to date. 

Automating the service is key to reducing the time spent on administration. Integrated PIFU brings automation benefits like tailored messages for specific pathways, changing the length of service and setting up additional monitoring requirements.  

Once set up, staff can spend more time with patients than spreadsheets. And the time it takes to set up each additional pathway is reduced as elements can be copied over rather than starting from scratch each time.  

Mitigating the risks 

Having tailored PIFU pathways delivered digitally is the best way to mitigate patient risk. Take a patient with a broken leg, for example. They would normally be booked in for their usual outpatient appointments at 3-, 6- and 9-month intervals before they have left the hospital. Does the risk increase if that patient is put directly onto a PIFU pathway? 

Effective communication is key here. Patients need to know they are being given a choice, and how to go about requesting an appointment if they need one. With the above example, that patient could be scheduled for a 6-month check-in with the ability to choose, if it is necessary, whether to have a 3-month or 9-month review as well.

This way the patient feels safe and looked after while having a point of escalation if the need arises while the hospital has just freed up several appointment slots.   

The potential for pathway redesign (and the benefits derived from it) gets larger when additional integrated solutions are considered. Appointments can be more effective with pre-clinic assessments or conducted remotely with a video solution.

For people living with long term health conditions, an appointment may not be needed at all and could be replaced with a digital follow-up assessment form that the clinician can review and decide on next steps. 

PIFU can often be viewed as a project in isolation rather than a part of wider digital transformation of a pathway. But the best way to scale PIFU that can save admin time, free up needed appointment slots and deliver an excellent patient experience is with an integrated, digital solution.