Could Patient Initiated Follow Ups be the key to enhancing PX whilst tackling growing waiting lists?
13th January, 2021
So, what is PIFU?
Prior to the Covid-19 pandemic, routine NHS outpatient follow-up appointments accounted for two thirds of all appointments, and around 15.4 million* of these slots were recorded as missed (DNAs).
NHSE/I recommended large scale implementation of Patient Initiated follow Ups (PIFU) to reduce overall appointment volumes, as well as help solve one of the fundamental issues with outpatient care, that many patients with long-term conditions are unable to access follow-up support when they need it. If they have a flare up or their symptoms worsen, it can be incredibly difficult to get an appointment as capacity has already been allocated for the foreseeable future.
PIFU allows the patient to arrange a follow-up as and when they need one rather than having unwanted routine appointments booked in advance, encouraging them to have more control over their own care, whilst freeing up capacity for patients who do need to be seen.
This process has been used on a small scale in Trusts over many years and may have also been known as Open Access appointments or Discharge SOS (Seen on Symptom). In these circumstances’ patients aren’t allocated an appointment but instead are entrusted to contact the hospital when they need clinical intervention.
Empowering patients to collaborate in their care
In the current pandemic the main benefit seems to be peace of mind that they won’t have to make unnecessary visits to hospital, which is understandably a concern for most people. Patients can get support when it is actually needed, and often from the comfort and safety of their own homes.
Long term, there are countless advantages to the PIFU approach which are based around empowering the patient as an active member in their healthcare journey. Appointments scheduled every 3, 6, 9 or 12 months when they aren’t wanted are unlikely to create any worthwhile changes to care. On a PIFU pathway patients can initiate a follow up consultation at any time, usually when they experience a flare up or a change in their circumstances, and are therefore able to access care much quicker than through traditional methods.
Opening up capacity to tackle growing waiting lists
Increasing capacity for NHS Trusts is of vital importance, particularly with the ever increasing backlog of patients waiting for treatment due to the Covid-19 pandemic. PIFU allows hospitals to remove redundant follow-up appointments and re use the vacated capacity for new or more complex patients, whilst improving patients access and experience of care, and minimising DNAs.
Another great tool within a digital PIFU model, is the ability to send patients videos, PDF’s, and links to support self-care which further activates the patients to collaborate in their treatment and in turn helps to reduce re-admission.
Typically, PIFU is most suited to long term conditions and post–surgical follow-ups as there is little to no chance of complications, but any outpatient appointment where the clinician wants to take a ‘wait and see’ approach can apply it. Let’s say a clinician advises a patient to try increasing their current medication with the option to come back only if it doesn’t work. The clinician can offer a timeline limited PIFU, such as ‘if there’s no improvement you can come back to see me within 4 months, but if it all gets resolved I don’t need to see you again’. This is another example of allowing patients to self manage their health whilst decreasing overall appointment volumes.
Never leave a patient behind
PIFU will be a valuable tool for providers’ during the COVID-19 recovery, and long after. However, it is crucial that it is implemented in a way that bolsters trust between clinicians and their patients, while supporting people to notice and act on changes in their symptoms. There is a risk that patients may not recognise triggers or changes in their condition, so establishing escalation points between patients and clinicians is crucial.
Setting up automated messages at key milestones ensures patients not seen within a certain window aren’t being left behind, and vulnerable groups won’t be disadvantaged with critical issues going unnoticed. If a patient on a PIFU pathway hasn’t activated it themselves, the consultant can also then choose to contact the patient and check in on them which is referred to as a CIFU (Clinician Initiated Follow Up).
Intelligent communications safeguard inclusivity
A major component in the execution of PIFU is the clever and innovative use of technology to manage pathways and allow for smooth, consistent communications. At Healthcare Communications we give you a choice of simple, easy to use initiation channels including SMS, phone, online and innovative new channels such as Apple Business Chat (ABC).
With 7 million people having NO internet access at home and 9 million people unable to even use the internet without help** inclusivity is at the forefront of our solution, providing accessible multi-channel communications that enable EVERY patient to self-manage their conditions. Feedback is received by the hospital in real-time, enabling a fast response to those patients in crisis, or providing advice where necessary.
‘Our PIFU model is clinician led, meaning that whilst Trusts can relax knowing that all patient content is clinically sound, we can provide reliable, automated processes to wrap around that content, providing scale, and importantly, freeing administrative and clinical capacity. We are working with Trusts at both ends of the scale; those who are implementing PIFU across the entire Trust (follow-ups only by exception), and those choosing to simply manage specific cohorts of patients efficiently.’
Concepta Wayment, VP of Transformation at Healthcare Communications
To find out more about implementing our digital first PIFU approach at your trust, email bookameeting@healthcomm.uk or call 0845 9000 890
*https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/