Recipe: a visit schedule built around a procedure date

What you get: a follow-up schedule that runs from each participant's own procedure date, not from the day they were registered. Staff record the operation, and the date they write on the form sets the participant's whole schedule: a pre-operative assessment beforehand, then visits at 6 weeks, 6 months and a year, each with its own tab on the participant's record. Correct the date and the schedule moves with it. Overdue visits show up on the trial overview, on each site's follow-up list and in a morning email, without anyone keeping a spreadsheet of due dates.

What you need: an anchor, stages scheduled from it, a stage group per visit and, if your team enters the data, the two Staff-completed stages settings.

This recipe joins up features that each have their own article. Read those for the details of each setting, then come back here for how they fit together:

The example

The steps below build a surgical follow-up study:

  • Before surgery: a Pre-operative assessment, completed by staff 14 days before the operation.
  • On the day: an Operation note, completed by staff, which records the Date of surgery.
  • Follow-up visits at 6 weeks, 6 months and 12 months. Each has a Clinical review that staff complete, and a Quality of life questionnaire the participant completes in the app.

The same shape works for anything that happens to each participant on their own date, such as randomisation, a first dose, a diagnosis or a discharge.

Step 1 — Build the form that records the event

Build the Operation note first, because the anchor takes its date from it. It is a staff form that records the event. On its Availability tab, choose Not available to participants, which is the eCRF setting: the form appears on the participant's record for staff to complete, and never in the app.

Make Date of surgery a required field. A blank date never sets the anchor, and the anchor never falls back to the date the form was submitted, so a participant whose note was saved without a date simply has no follow-up schedule.

Step 2 — Create the anchor

Go to Stages > Anchors and click Add anchor. Name it after the event, such as Surgery date. Do this before you build the visit forms, because the stage editor can only offer anchors that already exist.

Choose how each participant's date gets set. The date that matters is the day of the operation, not the day someone filled in the form, so take it from the form:

  • Assignment rule: When a stage is completed, with the stage Operation note.
  • Date to use: the Date of surgery field.
  • When the date changes: Follow the most recent date, so that correcting a mistyped date on the Operation note moves the schedule with it.

Scheduling before the event. A visit at a negative offset, such as the pre-operative assessment at day −14, can only appear once the participant has a date for the anchor. A date taken from the Operation note arrives too late for that. If you need visits before the event, set the anchor by hand on each participant's record when the operation is booked (Do not automatically trigger (manual only)), and correct it if the date changes. Each date you set by hand reschedules that participant's visits straight away.

Step 3 — Schedule the visits from the anchor

Open each visit form, go to the Availability tab and, under Schedule stage, choose Anchor-scheduled. Add one slot per visit, each with the Surgery date anchor and an offset in days:

Stage Who completes it Slots
Pre-operative assessment Staff −14
Clinical review Staff 42, 182, 365
Quality of life Participant 42, 182, 365

Each slot becomes a separate occurrence of the stage, with its own due date and its own response, so a participant's 6-week and 6-month Clinical review are two separate records. Set Clinical review and Pre-operative assessment to Not available to participants, and Quality of life to Available to participants.

Occurrences of an anchor-scheduled stage are named with the stage name, with %n replaced by the slot number. A stage called Quality of life (visit %n) reaches participants as Quality of life (visit 1), (visit 2) and (visit 3).

Until a participant has a date for the anchor, none of these stages appear for them. A participant with an empty schedule usually means a missing anchor date. Check their record first.

Visit windows

A visit usually has a window, such as 6 weeks ± 7 days. Trialflare doesn't have a target day with a window either side. A slot opens on its day and counts as behind schedule from midnight at the end of that day. Choose whichever of these suits the visit:

  • Open on the target day (slot 42). The visit is behind from day 43. This is simplest, and right where "behind" should mean "past the target".
  • Open at the start of the window and close at the end (slot 35, with Available for set to 336 hours, which is 14 days). The visit can't be completed before the window opens, and disappears from the participant's app once the window closes. It is behind from day 36, though, so it shows as overdue for most of its window. Tick Exempt from "behind" status if you would rather it didn't. A visit whose window closes without being done also stops counting towards the participant's progress, and is never counted as behind. Staff can still enter its data on the participant's record afterwards.

Either way, set Availability time on the stage if you would rather a visit opened at, say, 08:00 than midnight.

Step 4 — Make a tab for each visit

Go to Stages > Stage groups and create one group per visit, adding each stage with the recurrence that belongs to that visit:

Stage group Stages
Pre-op Pre-operative assessment
Surgery Operation note
6 weeks Clinical review (Recurrence 1), Quality of life (Recurrence 1)
6 months Clinical review (Recurrence 2), Quality of life (Recurrence 2)
12 months Clinical review (Recurrence 3), Quality of life (Recurrence 3)

Put them in visit order with the arrows. On a participant's record, a coordinator running the 6-month visit now opens the 6 months tab and sees exactly the forms that visit involves: their own review, and whether the participant has done their questionnaire.

Step 5 — Count the forms your team completes

By default, progress and "behind schedule" only consider forms participants complete themselves. In this study most of the forms are completed by staff, so under Settings > Participation > Staff-completed stages tick both:

  • Also include staff-only stages when measuring participant progress, so a participant whose 6-month Clinical review is outstanding isn't shown as complete.
  • Also include overdue staff-only stages in "behind schedule" checks, so an overdue review shows up as behind.

Each participant's Timeline tab then lists the staff forms too, with their due dates. See Trial overview: Counting forms staff complete for what else the settings change.

Step 6 — Keep the visits on track

With visits scheduled and counted, the follow-up work comes to you:

  • The morning follow-up list. Under Settings > Participation > Email updates, trial managers can get a daily or weekly email listing who is behind or due soon, what for and by when. Site staff can get the same list for their site from the site's Notifications tab. "Due soon" means due within the next 7 days, so the list gives clinics a week's notice to book the visit.
  • The site's Follow-ups tab. Each site's page lists its overdue and due-soon participants together, as a work list.
  • Reminders to participants. Add reminders to Quality of life so participants are nudged on each day it is open. To give them notice before a visit, add an automatic message under Messages > Automatic that sends relative to the Surgery date anchor, for example on day 41: "Your 6-week check-up questionnaire opens tomorrow."

See Recipe: re-engaging participants who fall behind for more on chasing overdue forms.

Step 7 — Test the schedule before you go live

Create a test participant and walk through it:

  1. Check that no visit forms appear before the anchor date is set.
  2. Complete the Operation note with a date of surgery 50 days ago.
  3. Check the anchor is set to that date on the participant's record, not to today.
  4. Check that the 6-week visit is open and overdue, and that the 6-month and 12-month visits show the right due dates on the Timeline tab.
  5. Check that the 6 weeks tab on their record shows the first Clinical review and Quality of life.
  6. Correct the date of surgery on the Operation note and check that the schedule moves.

Delete the test participant before you start recruiting.

When the date changes

A corrected date moves the whole schedule. With Follow the most recent date, correcting Date of surgery on the Operation note moves the anchor, and every visit is recalculated from the new date. A visit that has already been completed keeps its data.

A date set by hand takes over. If someone sets or corrects the anchor on the participant's record, the Operation note stops controlling it from then on. That is useful when the form is wrong and can't be corrected, but it means a later correction to the form won't move the schedule.

Editing the schedule applies to everyone. Changing a slot's offset changes it for every participant, including those already part-way through. Add a visit, or move one that nobody has reached yet, rather than moving one that participants have already completed.

Going further

More than one event. Anchors are independent of one another, so a study can schedule some forms from Surgery date and others from Discharge date, or from Randomisation. A single stage can even mix slots from different anchors.

One-off forms that follow an anchor. For a single form rather than a series, choose Make available after… with an Anchor date trigger and a delay in days, in place of an anchor-scheduled slot.

Different visits for different participants. Combine this recipe with branching a study on an answer: scope each visit form to a group, and only the participants on that path get those visits.

What this flow will not do for you

Nothing flags a missing anchor date. A participant whose anchor was never set has no visits, isn't behind, and doesn't appear on any follow-up list. Check that each participant's anchor date is set once their procedure has happened, and look out for participants with no visits on their Timeline tab.

No form appears on a booking. Trialflare schedules forms, not appointments. The visit opening is a prompt to complete it, not a clinic slot. Book the appointment the way you do now, and use the follow-up list to see who needs one.