PTU-093 Evaluating a nurse led inflammatory bowel disease hot clinic. (June 2019)

• Record Type: Journal Article
• Authors: Gethins, Sharon; Pattni, Sanjeev; Robinson, Richard; Duckett, Tracey; Walton, Jodie; Hiatt, Kelly
• Is Part Of: Gut. Volume 68(2019)Supplement 2
• Page Start: A236
• Page End: A237
• Publication Date: 2019-06
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.452
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Inflammatory Bowel Disease (IBD) can be an unpredictable condition with relapses requiring escalation of therapy and possible admission to hospital. The IBD Standards of Care recommend that patients with Crohn's disease and Ulcerative colitis have rapid access to specialist doctors and nurses so an appropriate and prompt plan of care can be implemented. Due to pressure on consultant Gastroenterology outpatient clinics, it is often difficult to see patients urgently who are acutely unwell. We recently evaluated referral pathways at the University Hospitals of Leicester (UHL) & identified a number of patients who were admitted that could potentially have been managed as outpatients. As a result, of this finding we implemented two IBD Nurse-Led 'Hot Clinic's' per week. Methods: The criteria for referral were an established or new diagnosis of IBD with significant exacerbation of symptoms potentially requiring admission. On referral, the IBD nursing team made an initial phone assessment to confirm severity. All patients with on-going symptoms were then offered an appointment within 5 working days. Results: Over a 12-month period, 67 patients were referred to the Hot Clinic. 37 (55%) self-referred via the IBD helpline, 11 (16%) were referred from endoscopy with active disease (6 from the 2 week-wait pathway) and13 (19%) direct from General Practice (GPs). 55 (82%) had a face-to-face consultation. 3 (5%) patients required admission to hospital and were admitted directly to a Gastroenterology ward; 2 (3%) patients were treated with oral prednisolone but were admitted two weeks after the Hot Clinic review via Urgent care, and their admission was expedited to Gastroenterology within twenty-four hours. 2 (3%) patients recently discharged following an admission contacted the helpline due to recurring symptoms and assessed in the Hot Clinic, and alteration in treatment prevented a readmission. A further 2 (3%) patients admitted in the Medical Admissions Unit were assessed by the In-reach Gastroenterology team and were able to be discharged early with urgent review in a Hot Clinic appointment. Nine (13%) patients were assessed over the phone, treatment was arranged which prevented a face-to-face consultation, and a plan of care was sent to both the patient and their GP. One patient declined an OPD and two never replied to calls or letters to contact the team. Conclusion: The introduction of ' IBD Hot Clinics' have allowed symptomatic patients with established IBD or newly diagnosed patients requiring urgent treatment, to be rapidly assessed by a specialist IBD nurse who can initiate appropriate treatments. This has shown to prevent admissions and fewer than 10% required admission in our cohort. The cost effectiveness of this service now requires further evaluation, with plans to expand this service.