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. 2022 Jun;92(6):1394-1400.
doi: 10.1111/ans.17676. Epub 2022 Apr 16.

Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic

Joshua Balhorn  1   2 , Bruce Su'a  1   2 , James Jin  1   2 , Sze-Lin Peng  1   2 , Maree Weston  1   2 , Lincoln Israel  1   2 , Andrew Connolly  1   2 , Andrew G Hill  1   2 , Ashish Taneja  1   2
Affiliations

Changing the routine: a move to patient initiated follow up to improve surgical outpatient clinic

Joshua Balhorn et al. ANZ J Surg. 2022 Jun.

Abstract

Introduction: Patient initiated follow up (PIFU) allows patients to initiate a hospital follow up appointment on an 'as required' basis in contrast to the traditional physician-initiated model. We present a clinical pathway for patients referred with rectal bleeding at a large tertiary public hospital in South Auckland, New Zealand and demonstrate the utility of PIFU and its impact on reducing follow up appointments.

Method: The purpose of the pathway was to allow standardized care by the clinicians and allow for PIFU. Two separate protocols were developed - 'Painful PR bleeding' and 'Painless PR bleeding'. A new clinic (NC) was started following these protocols, and this was compared to historical controls (HC). The primary outcome was the rate of follow up appointments.

Results: There were 133 patients in the NC and 135 in the HC, with significantly less follow ups in the NC (6% versus 45%, p < 0.0001). A small percentage of patients in the NC group were directly discharged (10%) whilst 70% of patients were discharged with a PIFU card. Thirty phone calls were made using PIFU, with 10 patients returning to clinic and 20 requiring advice and reassurance only. At 5 year follow up, there was a single colorectal malignancy found in both groups.

Conclusion: Initiating a protocol that includes patient initiated follow up vastly reduces the need for routine return to clinic for the majority of patients, without sacrificing patient care. A protocolised approach to clinic for other areas in general surgery should be considered.

Keywords: colorectal surgery; follow-up care; general surgery; haemorrhage; outpatient clinic.

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Conflict of interest statement

The manuscript has not been published previously and is not under consideration elsewhere. All authors agreement with the content of the manuscript.

Figures

Fig. 1
Fig. 1
Painless PR bleeding pathway.
Fig. 2
Fig. 2
Painful PR bleeding pathway.
See this image and copyright information in PMC

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