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P483. Impact of inflammatory bowel disease nurse specialist on quality of the patient journey

K. Kemp1, E. Fernandez2, I. Arnott3, 1University of Manchester/Manchester Royal Infirmary, School of Nursing/Gastroenterology, Manchester, United Kingdom, 2Royal College of Physicians, Clinical Standards Department, London, United Kingdom, 3Western General Hospital, Gastroenterology, Edinburgh, United Kingdom

Background

The 3rd round of UK IBD Audit was completed in 2010. There continues to be variation in the resource and quality of care for IBD patients. The aims of this further analysis of the national data were: to measure the quality of care for patients in centres with an IBD nurse >1 whole time equivalent (WTE), centres with an IBD nurse <1 WTE compared to centres with no IBD nurse; and to demonstrate the impact of the IBD nurse in terms of quality of care.

Methods

A comparison was carried out of the 2010 audit results of hospitals with no IBD nurse, <1 WTE nurse and those with one or more nurses. It cannot directly be inferred that the IBD nurse is the causative factor in the reduction in hospital admissions or improvements in care. The results also do not reflect the number of nurse sessions per week dedicated to IBD, how long the IBD nurse had been in post, nor the impact this may have had on the results.

Results

Of the sites that contributed organisational data, 57 sites had no IBD nurse, 40 sites <1 WTE and 105 sites had <1 WTE nurses in post. There was a significant reduction in the number of patients admitted to hospital with an IBD nurse in post and a difference in the range and choice of care delivery. More patient educational sessions were offered in the presence of the IBD nurse (28%, 60%, 71%, p < 0.001), more patient involvement in service development (12%, 20%, 39%, p < 0.001), clearer guidance for patients to seek a 2nd opinion (25%, 20%, 45%, p < 0.009) and clinical data more likely to be captured (23%, 50%, 61%, p < 0.001).

 IBD CNSp value
 None<1 WTE≥1 WTE 
% patients admitted to hospital 1st Sept 2009 – 31st Aug 2011 (IQR).18.7% (10.8–34.0)10.4% (5.1–23.3)10.8% (7.2–19.4)<0.001
The site offers a range of choices for outpatient care including email, drop-in, telephone.61% (35/57)85% (34/40)84% (88/105)0.002
The service offers guided self-management with access to support when needed.34% (12/35)62% (21/34)63% (55/88)0.013
There are arrangements for expedited specialist review of these relapsed patients.83% (47/57)98% (39/40)98% (103/105)0.002
There is a clear structured pathway for the patient to discuss their treatment with the multidisciplinary team16% (9/57)45% (18/40)57% (60/105)<0.0001
There is written information for patients with IBD on whom to contact in the event of a relapse42% (24/57)88% (35/40)95% (100/105)<0.0001

Conclusion

Reducing avoidable hospital admissions, increasing the proportion of people with IBD to self manage and the ability to offer choice of care are recognised as quality aspects of an IBD service. The presence of an IBD nurse, within the IBD team, correlates with fewer admissions, the availability of self management programmes and greater overall choice in care provision and new modes of care delivery.