1038 Introducing a Patient-Initiated Follow Up (PIFU) Pathway to a District General Hospital’s Urology Department: A Two-Cycle Quality Improvement Project Following the First 100 Patients

Abstract

Abstract Aim Outpatient appointments have almost doubled from 54 to 94 million in the last 10-years: 68% follow-up visits, costing £8 billion yearly. Patient-Initiated Follow Up (PIFU) enables patients to initiate follow up ‘as needed’ rather than attend routine follow-up. This project aims to introduce and improve a PIFU-pathway to reduce the 7% yearly increase in local follow-ups and improve patient satisfaction. Method Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a PIFU-pathway for new patients under a single consultant was established in a district general hospital’s urology department. Patients in clinic were given a letter with contact number should they request review. Those within 4-to-12 months of PIFU were quantitatively evaluated through retrospective health record analysis. A further PDSA cycle sought to improve the service by acting on patient opinions collected via telephone. Results 100 patients were evaluated with an average 6-months on PIFU. Mean age 58 years, 41% were female. PIFU indications: lower urinary tract symptoms (57%), stones (12%), UTI (9%), other (22%). Only 2% utilised PIFU, 98% sought no further appointments, 97% reported preference of PIFU over routine follow-up and improved satisfaction. 43% were unaware how to utilise PIFU; 91% either forgot about PIFU or lost PIFU contact information. Subsequent interventions include development of introductory and reminder texts, an email address, and specific webpage. Conclusions The project suggests PIFU can reduce the number of unnecessary outpatient appointments in secondary care, whilst improving patient satisfaction and without compromising care across numerous chronic urological conditions. Clinicians can subsequently target active problems or waiting list control.