PIFU 1-1

PIFU – AIDING PATIENT CARE OR ADDING MORE RISK? 13.07.21

Delivering Patient Initiated Follow Ups (PIFU) is a key part of the NHS's response to the COVID-19 pandemic, and is part of the outpatients transformation requirements laid out in the 2021/22 Operational Planning Guidance aimed at helping providers and systems manage waiting lists safely and see patients most in need more quickly.

As Trusts look to implement PIFU across their services, they need safe tracking and monitoring of these patients to ensure they don’t get lost in the system – experience shows that managing patients on spreadsheets and disparate lists are both high-risk activities.

Benefits and risks of PIFU

PIFU has huge benefits, saving patients from making unnecessary journeys into hospital, reducing the number of outpatient visits that do not add any value, and freeing up clinic time to tackle the post-covid elective backlog. PIFU is not new – hospitals have been offering open access to selected patients for years – but it is now being done on an unprecedented scale.

The NHS is right to tread carefully when implementing PIFU. It isn't suitable for all clinical conditions, for instance, because the progression of some diseases can only be measured with specialised equipment. And there are administrative risks to patients too. The Healthcare Safety Investigation Branch (HSIB) recently highlighted the case of Pauline, who died after follow-up appointments were not made, citing the lack of joined-up IT systems and the importance of tracking every patient.

This is where Patient Pathway Plus (PP+) comes in. PP+ is a powerful data platform that connects directly with the source systems to extract, process, validate and unify data automatically. It provides a ‘single version of the truth’ for tracking and managing each and every patient, and NHS Trusts tell us that it reduces the number of missed patients to zero.

Eliminate spreadsheets to reduce errors

The PIFU guidelines define some key tracking and metrics for implementing PIFU safely. Some relate to the mechanics of recording and managing PIFU patients on IT systems that were not necessarily designed with PIFU in mind. For instance: to ensure that all PIFU patients are contacted from time to time; to detect patients who have got lost in the system; and to make sure that PIFU patients get a responsive service when they do request a follow-up.

But there are also important overall metrics that senior managers can use to detect whether the PIFU services are working as intended, such as unusual changes in the numbers of patients:
  • Starting or ending PIFU
  • Requesting PIFU appointments, or requesting multiple appointments
  • Being overdue for a required follow-up or discharge
  • Being referred by their GP when they are already on PIFU
  • 'Did Not Attend' rates for PIFU appointments
  • Reporting a poor experience on the Friends & Family Test

Some Trusts find it challenging to implement these tracking and monitoring priorities because, as the HSIB identified, they require clean links between IT systems that weren't designed to talk to each other. So, they often end up using other tools, such as spreadsheets, to track and manage these patients. Not only is this time consuming, but it brings the risk of manual input errors and discrepancies, making it very difficult to maintain good quality data and provide the assurance patient pathways need. The other problem is that data is perishable, and spreadsheet lists start going out of date the moment they are created.

PP+ unifies the necessary data to give organisations an accurate view of their waiting list backlog across all elective care, not just RTT, enabling management across the full patient journey, including follow ups. By tracking and managing all elective activity, including PIFU, in a common digital platform, manual data processes are removed, and we can eliminate the need for vulnerable spreadsheets in patient pathway management.

PP+ stops PIFU patients getting lost in the system

Let’s finish with a quick rundown of how PP+, stops PIFU and other patients from getting lost in the system.

PP+ works by unifying all the necessary data, linking the pathways together in painstaking detail, and meticulously checking them for inconsistencies in a digital platform for tracking and managing all elective pathways, both RTT and non-RTT.

PP+ provides a ‘single version of the truth’ for all elective activity, that can used at a trust or regional level – or even national level – to show the precise status of all elective patients at any point in time.

If the NHS is to truly aim for elective recovery, organisations need to be able to manage ALL elective patients safely and with confidence that the data is accurate. And that goes for PIFU patients as much as anyone else.