N001 IBD clinical nurse specialist telephone advice lines: a clinical audit on the standard of information and outcomes.
M. O'Connor*, A. Hart, N. Arebi
St Mark's Hospital, IBD Unit, Middlesex, United Kingdom
Inflammatory Bowel Disease (IBD) clinical nurse specialists (CNS) provide direct telephone access via 'advice lines' to support patients during disease relapses (Phillips, 1995, Mowat et al., 2011). The intention is to analyse the nursing advice given in relation to the current IBD guidelines, and patients' clinical outcome.
A retrospective audit of 50 randomly selected telephone calls received to the telephone service at a large tertiary London hospital between 1st of March 2013 until 28th of February 2014 was undertaken. Records generated from the calls were retrieved and further analysis was restricted to patients who called to discuss a relapse of their IBD divided according to disease type. The documented advice was compared with the recommendations of the current IBD management guidelines (Dignass et al. 2010; Dignass et al. 2012b; Mowat et al. 2011). The documented patient outcomes following the calls were also analysed.
Fifty four percent (n=27/50) of calls were from patients reporting a relapse; ulcerative colitis (UC; n=17) and Crohn's disease (CD; n=10). 96% (n=16/17) of UC and 60% (n=6/10) of CD patients were dealt with by advice, and the advice given was consistent with the guidelines in all cases. 100% of the UC and 100% of CD group had their call returned within the next working day (IBD Standards Group, 2013).
Six patients re-called the service after two weeks and the majority (n=5/6) were provided with further advice to manage their relapse. Two patients were provided with a clinic appointment within 5 working days (IBD Standards Group, 2013) and three patients were advised to attend the emergency department and an elective admission to hospital was arranged for a further patient (n=1).
Twelve patients required involvement by the patient's general practitioner for a medication prescription (n=9) or consultation (n=3).
This audit has demonstrated that the IBD CNS plays a pivotal role in the management of patients experiencing a relapse. They reply promptly, offer clinical advice compliant within the published IBD standards and optimise patient outcomes by directing patients towards an appropriate service: clinic appointment, hospital admission or medical therapy via the GP according to needs. Future studies should explore whether the use of disease severity indexes including HBI and SCCAI (Harvey et al. 1980; Walmsley et al. 1998) during the telephone nursing assessment may allow better assessments particularly to monitor progress for repeated calls. The tools may enhance communication with the GP whereby a score highlights the disease severity which may be delivered via brief email message with treatment recommendations.