Debbie Adger: Putting orthopaedic patients in control with PIFU

For patients recovering from orthopaedic surgery, the follow-up process can feel like a one-size-fits-all approach, with rigid appointment schedules that may not align with their individual needs.

One solution increasingly used in the NHS are patient initiated follow up (PIFU) appointments, allowing patients to initiate their own appointments when they feel it's necessary, rather than being bound to a predetermined schedule.

This patient-centric approach not only enhances flexibility and convenience but also promotes self-management and personalised care.

West Suffolk NHS Foundation Trust (WSH) is one trust making use of PIFU appointments to help patients who have undergone orthopaedic surgery to take charge of their follow-up care.

First introduced in 2022, the trust has significantly increased the number of orthopaedic patients transferred onto the PIFU pathway, with excellent results for patients and clinicians.

One of the key outcomes of the PIFU implementation has been the significant shift in outpatient activity.

In May 2023, 27.5 per cent of outpatient activity was moved to a PIFU pathway, demonstrating the Trust's commitment to transforming the follow-up care experience.

Currently, 2,334 orthopaedic patients are managing their outpatient appointments on a PIFU pathway at WSH.

Of these, one per cent of PIFU patients have requested a follow up appointment, which the trust says is manageable enough for patients to be effectively triaged and slotted into existing clinics without the need for additional resources.

At the heart of WSH's PIFU successful implementation lies a set of key principles that have guided the process:

• Inclusivity: Any orthopaedic patient can be eligible for PIFU, but it's not a replacement for discharge; it's an alternative follow-up pathway.
• Collaborative effort: All members of the orthopaedic team, including plaster technicians, nurses, physiotherapists, and junior doctors, can identify and recommend patients as potential candidates for PIFU.
• Patient education: Consultants play a crucial role in offering PIFU to patients and explaining the process, ensuring they understand how it works and can make an informed decision.
• Streamlined documentation: If a patient chooses PIFU, this is recorded on their electronic patient record.
• Patient-friendly resources: Patients receive a wallet-sized card with all the information they need, including the date their PIFU pathway will close and the contact number to call if they require a follow-up appointment.

The trust’s PIFU journey hasn’t been without its challenges, however.

As the program continues to evolve, capturing and understanding patient experiences with PIFU over the length of the pathway continues to be crucial.

In the longer term, the trust believes their clinic templates may need to be reviewed to accommodate the changing dynamics of follow-up care.

Despite these considerations, the trust's PIFU implementation has been a resounding success, thanks to the collaborative efforts of the entire orthopaedic team.

From consultants to support staff, everyone has played a vital role to deliver this transformative change.

By putting patients in control and offering them the flexibility to initiate follow-up appointments when they truly need them, the trust is paving the way for a more personalised and empowering healthcare experience.

For the wider NHS, WSH's PIFU implementation is a blueprint for other healthcare providers seeking to enhance patient-centred care and support self-management in follow-up pathways.

Further information

Guidance from NHS England outpatient recovery & transformation team on orthopaedic PIFU pathways can be found here:

• Hip replacement pathway
• Total and uni primary knee replacement pathway
• Guide to implementing PIFU in adult trauma and orthopaedic secondary care pathways
• Guidance for patients seen in trauma and orthopaedics – fracture clinic

More information on PIFU is also available at NHS England.