ArticleAnnals of the Royal College of Surgeons of England2026
The impact and utilisation of patient-initiated follow-ups (PIFU) in the elective upper-limb clinic at secondary care.
Article in Annals of the Royal College of Surgeons of England, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Patient-initiated follow-up in surgical specialties: meta-analysis and meta-regression.BJS open · 2026Pooled it
- Assessing the properties of an encounter-based "process of recovery" measure of patient benefit following rotator cuff repair.JSES international · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMusculoskeletal (MSK) conditions affect over 20 million people in the UK. Follow-up appointments account for nearly two-thirds of all outpatient activity. Patient-initiated follow-up (PIFU) allows patients to request follow-up appointments based on clinical need, aiming to reduce unnecessary reviews and optimise service use. This study evaluated the impact and utilisation of PIFU in a secondary care Elective Upper Limb (Shoulder and Elbow) Clinic, focusing on patient engagement, re-presentation rates, and suitability across common upper limb conditions.
methodsA retrospective service evaluation was conducted over 18 months. Patients discharged under the PIFU pathway were included if they had at least six months' follow-up opportunity. Data collected included diagnosis, treatments received, re-presentation rates and outcomes. Descriptive analysis was used to assess patterns and clinical implications.
resultsOut of 353 consultations, 81 patients (23%) were discharged to PIFU. Among these, 62% were first-time referrals discharged at their initial appointment. Conditions most suitable were rotator cuff-related pain (33%), early glenohumeral arthritis (19%) and adhesive capsulitis (10%). Within six months, only 18% of PIFU patients re-accessed care - just 4.2% of the total cohort. One-third of returning patients required surgery, while the remainder were managed nonoperatively and re-entered the PIFU pathway. PIFU freed approximately 20% of follow-up slots.
conclusionsPIFU is a safe and effective follow-up model for stable or early-stage shoulder and elbow conditions, reducing outpatient burden, supporting patient autonomy and preserving clinic capacity without compromising care quality. Broader implementation, supported by patient education and structured feedback, may enhance sustainable delivery of orthopaedic services.
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