18. The quality of care for inpatients with inflammatory bowel disease in the UK over a six year period
L. Alrubaiy1, I. Arnott2, A. Protheroe3, M. Roughton3, J. Williams1, 1College of Medicine, Swansea University, Swansea, 2Western General Hospital, Edinburgh, 3Royal College of Physicians, London, United Kingdom
Since 2005, three national audits have been conducted to assess the quality of Inflammatory Bowel disease inpatient care in the UK. Our aim is to examine the quality of care provided for inpatients with IBD in the UK in the last 6 years.
NHS trusts/ Health boards in the UK which routinely admit IBD patients were invited to participate in three national audits. Data were collected on adult patients with IBD admitted to hospital between 01/06/2005 to 31/05/2006; 01/09/2007 to 31/08/2008; and 1/9/2010 to 31/08/2011 if the primary reason for admission was inflammatory bowel disease. Data related to individual patient care, services resources and organization were collected for the three audit rounds. The audits data were based on national standards. Comparisons across the three rounds of audit were made using chi-square test, with a p value of <0.05 taken to be statistically significant.
Participation in these audits by UK hospitals rose from 75% in the first round to 93% and 90% in the second and third rounds respectively. The total numbers of inpatients were 2767, 2981, and 3049 patients with ulcerative colitis and 2914, 3154 and 3122 patients with Crohn's disease in the 1st, 2nd and 3rd audit rounds respectively. For ulcerative colitis, the inpatient mortality rate fell from 1.7% in the 1st round, 1.5% in the 2nd round, to 0.8% in the 3rd round (p = 0.034). For Crohn's disease the inpatient mortality dropped from 1.3% in the 1st round, 1.1% in the 2nd round to 0.8% in the 3rd round (p = 0.226). There have been specific improvements in many areas covered by the National Service Standards for Inflammatory bowel disease. The number of admissions remained almost the same in the last few years, but the number of admissions per patient has reduced. The collection of stool samples;use of prophylactic heparin;prescription of bone protection agents;and use of anti-TNF therapy as a rescue therapy has increased. There has been a reduced frequency of surgery in non-elective admissions with a significant increase in the percentage of operations performed laparoscopically. A significant increase in the percentage of inpatients reviewed by the IBD specialist nurses during their admission. High proportion of patients was not reviewed by dietetic services.
It is clear that the care of patients with inflammatory bowel disease, severe enough to warrant admission, is improving, and suggests regular national audit against clear standards is an effective catalyst for change.