N30 Understanding Inflammatory Bowel Disease Emergency Department Admissions in a Tertiary Referral Inflammatory Bowel Disease Centre in England: A quality Improvement project
Avery, P.(1)*;Younge, L.(1);Arebi, N.(1);
(1)St Marks Specialist Bowel Hospital and Academic Institute, Inflammatory Bowel Disease, London, United Kingdom;
In February and March 2022, the emergency department (ED) affiliated to a tertiary referral inflammatory bowel disease (IBD) centre in England undertook an audit of ED attendances as part of an IBD-related admission quality improvement project (QUIP). Quality standards recommend review within 5 days of a flare. Patients presenting to ED may reflect failure of urgent GP access or to the IBD advice line a marker of poor-quality care.
Patients with suspected IBD presenting to ED during the audit period were identified the initial results generated further questions for the IBD team. A excel data base was created and the electronic patient record for each patient was retrospectively reviewed. Data relating to previous contact with the IBD team, how patients were referred to ED and confirmation of an IBD diagnosis was collected. Descriptive statistical analysis was used to present the data.
There were N=48 ED attendances with a suspected diagnosis of IBD between February and March 2022. From the N=48 attendances from n=41 patients, n=29 (60.42%) admissions occurred for these patients. n=19 (39.58%) episodes resulted in discharge with five of these being self-discharges. of the n=41 patients n=4(9.76%) did not have a diagnosis of IBD n=1 (2.44%) with a diagnosis of IBD was not known to the IBD interdisciplinary team. Additionally, n=2 (4.88%) were new patients neither were known to the IBD team and n=2 (4.88%) were suspect diagnosis. multiple attendances occurred and n=1 (2.44%) patient attended four times and n=4 (9.76%) patients attended twice each meaning n=5 (12.2%) of the patients were responsible for n=12 (25%) of attendances. Of the original N=48 attendances, n=32 (66.67%) attendances occurred with no contact to the IBD advice line and n=19 (46.34%) of the n=41 patients responsible for these attendances. The outcomes are summarised in Table 1.
The original QUIP data was incomplete, and the actual IBD ED attendance rate was 66.66% of the original quoted figure, raising the importance of data cleaning and quality in QUIP. Focusing in on the 32 attendances where patients did not call the advice line, improvements to the messaging that IBD advice line service is available has become a priority as has utilising advanced nurse practitioner and specialist registrar skills to support patients therefore avoiding some of this ED attendance in the future. So far, adding advice line details to clinic letters, advertising in clinic, and setting up rapid access flare clinic led by Advanced Nurse Practitioners from the IBD Nursing team have been implemented. There are plans to review the attendance at IBD patients in ED in the same period in 2023.