The Royal College of Ophthalmologists (RCOphth) and the ophthalmology department at King’s Mill district general hospital (DGH) collaborated on a case study detailing how King’s Mill developed its patient initiated follow up (PIFU) offering in general ophthalmology, and the impact it has had on unit capacity and patient outcomes, as part of a wider set of actions.
Ophthalmology is the busiest outpatient specialty and remains under pressure to safely reduce outpatient waiting lists. NHS England has identified PIFU as one way of helping to achieve that goal in its 2022/23 planning guidance, having provided guidance on implementing PIFU and more recently publishing guidance on reducing ‘did not attends’ in outpatient services. RCOphth hopes that this case study will provide useful practical information as you consider implementing a PIFU model in your eye unit. As part of wider efforts to address outpatient backlogs, you may also find helpful our 2020 guidance on prioritising outpatient appointments.
Structure of King’s Mill ophthalmology PIFU offering
The King’s Mill ophthalmology unit – sitting within a DGH in Nottinghamshire – provides an in-depth look into the challenges and opportunities presented when developing PIFU pathways. We spoke to the clinicians and administrative team involved in the work to understand their experience of setting up ophthalmology PIFU and to explore the structure they implemented.
The King’s Mill ophthalmology PIFU offering is structured as follows:
- Supported triaging – Patients are triaged as usual, before being seen by a clinician who then identifies whether the patient is appropriate to be placed on a PIFU pathway. The clinician can reference the ‘ophthalmology PIFU framework’ – developed by ophthalmologists in the unit – which identifies the eye conditions and associated criteria that must be met for a patient to be placed on a PIFU pathway.
- Patient consent – A shared decision-making conversation is then held between patient and clinician about their suitability and willingness to sit on a PIFU pathway. If the patient agrees, they are informed about next steps by the clinician, using the ophthalmology PIFU ‘Patient Communication Script’.
- Effective monitoring – Patients are then placed on a purpose-built patient administration system (PAS) – co-created by clinicians and administrative staff – which monitors the date patients are placed onto PIFU, the date the patient requests an appointment (activation date), and the time between the activation date and the follow-up appointment.
Underpinning this model are four key support factors: strong clinician and patient engagement throughout the process of PIFU development, administrative support in devising a PIFU-specific PAS, clinic capacity in order to have the space to undertake PIFU development work, and adaptation to the unit’s unique requirements taking into account its size, resources, demographic and clinical profile of patients attending the unit, and sub-specialty requirements (in this case general ophthalmology).
PIFU development has supported expanded capacity, with patients and staff feeling empowered
Though the King’s Mill ophthalmology unit has also taken several other steps to reduce outpatient backlogs, since the development of its PIFU offering the unit has reduced its overdue referrals by 80% compared to 2020 levels – from 8,000 in 2020 to 1600 in 2023 – with no referrals more overdue than 13 weeks.
In addition, the unit has saved almost 2,000 outpatient appointments through PIFU, averaging a saving of over 100 appointments per month. These saved appointments are then repurposed allowing clinicians to deal with more complex cases while saving patient time.
“PIFU is helping to better prioritise patient appointments, although it does create more challenging clinics for us as clinicians!” – Consultant ophthalmologist, King’s Mill Hospital
Patients have been happy with the move to PIFU, with the unit having received no complaints and a sense of patients feeling empowered with the extra responsibility while knowing they can be seen at a time of their choosing if they do request an appointment. Feedback from within the unit has been positive too, with clinicians happy to have a more efficient system in place facilitating a higher throughput and allowing them to treat more complex cases.
PIFU development prompting further innovations
Following the initial development of general ophthalmology PIFU at King’s Mill, the unit has a number of key sub-specialties it wants to either expand the offering to– namely paediatric ophthalmology – or to improve the current operation of existing PIFU pathways.
While PIFU has been successful in supporting tackling backlogs, King’s Mill continues to work with triaging nurses to make better decisions when calling patients back, given clinic space is at a premium – a challenge many units currently face as highlighted in the RCOphth 2022 workforce census.
To view the case study in full alongside a set of materials related to the King’s Mill process – including the Ophthalmology PIFU Framework, PIFU flow-chart, and patient communication script – please follow this link.
To read a full write-up of the webinar exploring the role PIFU has in improving ophthalmology outpatient services held following publication of the case study – please follow this link
If you have any questions or comments, please contact [email protected]