P121. Specialized IBD management at emergency room limits the need for hospital admission in IBD patients
M.I. Pérez-Amarilla1, C. Taxonera2, D. Olivares2, J.L. Mendoza2, M. Cañas2, N. López-Palacios1, M. Díaz-Rubio1, J.M. Ladero1
1Hospital Clínico, Gastroenterology, Madrid, Spain; 2Hospital Clinico Madrid, IBD Unit; Gastroenterology Division, Madrid, Spain
Background: Patients with inflammatory bowel disease (IBD) frequently attend the emergency room, where they are seen by personnel without specific training in IBD. This may result in some patients being admitted to hospital unnecessarily while others in need of hospitalization are sent home. Assessment by IBD specialists in the emergency room could help rationalize the need for admission in IBD patients. The aim of our study was to assess the results of an interconsultation strategy for IBD patients who attend the emergency room.
Methods: Descriptive, retrospective study of the findings of 100 interconsultations (events) resolved in the emergency room by specialists belonging to the IBD unit. The primary endpoints were (1) patients requiring admission to hospital, (2) hospital admission among discharged patients (at 4 weeks after discharge) and (3) need of discharged patients to return to the emergency room (4 weeks after discharge). Factors predictive of the need for admission or readmission were analyzed.
Results: 100 events in 87 patients were analyzed over a 2‑year period. Patients had a mean age of 47 (95% CI, 4351) and 47% were female. The 100 events occurred in 38 patients with Crohn's disease; 35 with ulcerative colitis; 4 with colitis of unspecified etiology and 23 without confirmed diagnosis. 25 of the 100 events resulted in direct hospitalization. 62 events (62%) were diagnosed of moderate to severe IBD flare, only 17 (27.4%) of them ended in hospitalization. Of the 75 events ending in the patient discharged and sent home, 6 patients (8%) finally required hospital admission in the following month. Only 1 of these 6 patients was referred from the emergency room, the remaining 5 were admitted directly. Only 1 of the 75 events (1.3%) resulting initially in discharge required the patient to attend the emergency room again. This patient was finally hospitalized. In 13% of the events, patients who were initially discharged required an emergency visit to the IBD Unit (open access) in a mean time of 8.2 days. With regard to the factors predictive of admission (31 admissions, 25 initial and 6 discharged to home) only steroid-refractory status was significant (p < 0.003).
Conclusions: Assessment by specialists in IBD in the emergency room can limit the need for hospital admission. In a population with 62% of patients having a moderate to severe IBD flare, only 1 in 4 patients needed hospitalization. Discharge to home from the emergency room seemed appropriate as only 8% finally required admission.