P358 Keeping it simple: How a streamlined referrals process reduces the time taken to initiate biologic therapy
Granger, E.(1);Heyes, E.(2);Cahoon, E.(2);Riley, G.(2);Kwok, J.(2);Shuttleworth, E.(2);
(1)East Lancashire Hospitals NHS Trusts, Gastroenterology, Blackburn, United Kingdom;(2)Lancashire Teaching Hospitals NHS Trust, Gastroenterology, Preston, United Kingdom;
Background
The process of commencing IBD patients on biologic therapy is logistically complex. Most biologic therapy is administered via a subcutaneous or intravenous route, so in addition to a negative pre-biologic screen, patients must be educated on subcutaneous self-administration or booked into an infusion’s clinic. A delay of over 40 days in starting biologic therapy results in statistically worse self reported GI symptoms and endoscopic appearances at one year1. Therefore, reducing the time between the decision to initiate biologic treatment and the administration of the first dose is a key factor in improving outcomes.
Methods
A retrospective review of clinic letters, appointment dates and email exchanges was performed for all IBD patients commenced on outpatient biologic therapy (Adalimumab, Infliximab, Vedolizumab, Ustekinumab, Golimumab and Tofacitinib) by the Gastroenterology team at Lancashire Teaching Hospitals NHS Trust between February 2019 and September 2021.
The length of time between the decision to initiate biologic therapy and the administration of the first dose was recorded in days. For cases where this time period was greater than 28 days, the reason for the delay was categorised into either patient factors; logistical; outstanding biologic screen; outstanding clinical question; homecare delay or no single factor.
A tracking spreadsheet and generic referral email address were introduced in March 2021 and the impact of these interventions was assessed via run chart.
Results
The median time period from the decision to initiate biologic therapy to administration of the first dose was 35 days at the start of the study period, with 67% of patients waiting over 28 days.
Following the interventions in March 2021, despite twice the number of patients, the median wait time was reduced to 20 days with only 23% of patients waiting over 28 days.
Outstanding biologic screens and logistical factors such as delays in letter typing were the most common reasons for delays. Only 17% of cases where communication was via email had a wait time of over 28 days, compared to 75% of cases where communication was via letter.
Conclusion
Simple adjustments such as a dedicated tracking spreadsheet and switching to email communication have a big impact on streamlining the process of initiating biologic therapy, almost halving the time taken from decision to initiate therapy to administration of the first dose.
1 System delays have real consequences: Impact of timing of biologic commencement on inflammatory bowel disease patient response A McCulloch, Journal of Crohn's and Colitis, Volume 13, Issue Supplement_1, March 2019, Page S176