IBD 1 Implementation of an electronic clinical management system for paediatric inflammatory bowel disease biologic multi-disciplinary team meetings- experiences from a tertiary gastroenterology centre. (12th September 2022)

• Record Type: Journal Article
• Authors: Taylor, Pippa; Selvarajan, Lakshmi; Wiskin, Anthony; Lee, Kwang Yang
• Is Part Of: Frontline gastroenterology. Volume 13(2022)Supplement 1
• Page Start: A36
• Page End: A37
• Publication Date: 2022-09-12
• Subjects: Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1136/flgastro-2022-bspghan.51
• Languages: English
• ISSNs: 2041-4137

Abstract

Abstract : Introduction: A multidisciplinary team (MDT) approach facilitates the holistic care of children with inflammatory bowel disease (IBD). The 2019 national IBD standards recommend the use of an electronic clinical management system (CMS) to coordinate care efficiently, as well as provide a tool for quality improvement. We describe our experiences of implementing the Infoflex CMS for Biologic MDT meetings and the impact on clinical outcomes. Background: A one-hour monthly Biologics MDT meeting was established in May 2020 co-ordinated by the clinical nurse specialists, and attended by paediatric gastroenterologists, clinical nurse specialists, and dieticians. Prior to CMS implementation, meetings were co-ordinated using Microsoft Excel spreadsheets. This had multiple limitations – it did not provide an accurate list of patients and was unable to capture updates in patient care. Outcomes had to be documented in a different system, and letters created in a third system. To address these issues, the Infoflex CMS was adopted for use at the biologics meeting. Patients on biologic therapy were listed for an Annual Biologics MDT in Infoflex, generating a worklist of patients. Clinical data was entered onto the system in advance to facilitate effective discussions. After discussion, action points were identified and recorded in Infoflex. These actions were reviewed at the next meeting, and marked as complete once performed. Methods: We reviewed outcomes for patients discussed in the biologics MDT meeting from inception (May 2020) to 31 October 2021. Data was retrieved from the Infoflex PMS (Version 5.70.130, Civica) and analysed using Microsoft Excel (Version 14.0, Microsoft). Results: In 17 months, 78 MDT discussions were held for 61 patients, representing 51% of our 119 paediatric IBD cohort on biologics or small molecules. 17 patients were discussed twice in separate MDTs. Of the 61 patients discussed, 35 (57%) were male. 42 patients had Crohn's disease, 10 patients had ulcerative colitis, and 9 patients had inflammatory bowel disease- unclassified (IBD-U). Median age of patients at discussion was 14.5 years (range 5.8–16.7). 36 (59%) patients were on infliximab, 20(33%) on adalimumab, 3 (5%) on vedolizumab, and one patient each on ustekinumab and tofacitinib. The MDT recommended changes in management in 38 (49%) cases. Further disease assessment was requested in 29 cases. These included repeat calprotectin (17), further imaging or endoscopy (6), drug or metabolite levels (11) and genetics (2). Medication changes were made in 11 cases. Infliximab frequency was increased in two patients. Biologics were stopped in two patients, and biologic switched in three patients. Azathioprine was started in one patient and stopped in two patients. One patient was started on Vitamin D. Discussion: The Biologic MDT can provide a safe and effective framework for IBD patients on biologic agents. The Infoflex CMS has allowed clinical data to be summarised, and outcomes and actions from the MDT to be managed and communicated, all within one system. This streamlines the processes involved whilst also providing a data collection to feed in to both local and national audit.