N007 Effects of introduction of an inflammatory bowel diseases nurse position on the quality of delivered care
S. Coenen*, E. Weyts, S. Vermeire, M. Ferrante, M. Noman, V. Ballet, G. Van Assche
UZ Leuven, Gastroenterology, Leuven, Belgium
Inflammatory bowel diseases (IBD) are chronic gastrointestinal conditions that require long-term outpatient follow-up, ideally, by a dedicated, multidisciplinary team. More and more, a key role has been proposed for the IBD nurse. IBD nurses serve as the first point of contact for patients, and they provide frequent and easy access to education, advice, and support aimed at improving in outcomes. We investigated the effect of the introduction of an IBD nursing role on the delivered quality of care within an IBD referral centre.
In our tertiary referral IBD centre, an IBD nurse position was instituted in September 2014. All contacts (phone, email, or personal contact) and outcomes were prospectively recorded over a 12-month period, using a logbook kept by the nurse. Interventions were categorised as prescriptions and attestations, flare management, starting new therapy, follow-up on therapy, disease information and support, questions about side effects, psychosocial support, and planning of follow-up.
Between September 2014 and August 2015, 1 312 patient contacts were recorded (with 42% male, median age 38 years, and 72% Crohn’s disease). Most of those were phone calls (48%) and personal contact (46%) and a minority e-mails (6%). The contacts increased with time: Q1 (September–November 2014): 144, Q2 322, Q3 477, and Q4 370. More than half of the patients who contacted the IBD nurse (58%) were taking biologicals. The vast majority of contacts (94%, 1229/1312) could be handled independently by the nurse, whereas medical staff back up was needed for 6%. Further, 10% (137/1312) of the contacts were for patients with recently diagnosed disease (<1 year). Most of the contacts of the IBD nurse were assigned to the start of new therapy (12%) and the follow-up of these medications (22%), to the planning of follow-up (22%) and to providing disease information (16%). In addition 9% of the patients contacted the IBD nurse for flare management; 8% for prescriptions and attestations; 7% for psychosocial support; and 3% for questions about side effects. In the study period, 30 emergency room visits were avoided by conversion into outpatient clinic visits through the intervention of the IBD nurse and 133 unscheduled outpatient appointments were be avoided through counselling. The IBD nurse provided faster access to procedures and other departments related to IBD for 136 patients.
The role of IBD nurses as first point of contact and counselling is evident from a high volume of nurse-patient interactions that increased 3 fold within the first 6 months. Avoidance of emergency room and unscheduled clinic visits, and improved access to procedures were associated with these contacts.