N019 The inflammatory bowel disease (IBD) dedicated day service planned by IBD specialist nurse: a good and time-saving approach to IBD or suspect IBD patients
S. Biagini, M. Giannotta*, V. Almerigogna, A. Cozzi, G. Macrì, M. Milla
AOU Careggi, Regional Referral Centre of Inflammatory Bowel Disease - Clinical Gastroenterology Division, Florence, Italy
Achieving diagnosis or re-evaluation in IBD can be challenging and time consuming for both clinicians and patients.
An IBD dedicated Day Service (DS) was settled at our centre for patients with clinical suspicion of IBD and patients with exacerbation or need of re-staging of an already diagnosed IBD. We directly performed at our centre blood collection for routine examinations or screening for immunomodulators (IMM), and endoscopies and bowel ultrasound. In addition, we scheduled patients for other procedures such as radiology (CT, MRI, and chest X-ray) or specialists consults at our hospital. The timing of DS procedures was planned by an IBD specialist nurse under the indications of the IBD gastroenterologist.
In total, 26 patients were evaluated at the IBD dedicated Day Service (DS) of our Centre, 15 patients (8 UC and 7 CD) because of IBD flare, 5 patients (all affected by CD) for disease re-staging, and 6 for clinical suspicion of IBD. In the ‘flare’ group we performed 13 routine blood exams and 12 IMM screening, 11 colonoscopies, 10 bowel ultrasounds, 2 MRI or CT, and 1 rheumatologically visit. In 9 patients out of 15 (60%) maintenance therapy was shifted towards an IMM; 1 patient (6.7%) underwent surgery; and 5 patients (33.3%) did not change maintenance therapy after DS conclusion. Mean DS duration was 16 working days (range 2–35), with a mean loss of 2.6 working days per patient. In the ‘restaging’ group, we performed 4 routine blood exams and 3 IMM screening, 3 colonoscopies, 3 bowel ultrasounds, and 2 MRI or CT. Further, 2 patients out of 5 (40%) started IMM therapy, and 3 patients (60%) did not change maintenance therapy after DS conclusion. Mean DS duration was 32 working days (range 26–42), with a mean loss of 2.6 working days per patient. In the ‘suspect IBD’ group we performed 6 routine blood exams and 2 IMM screening, 5 colonoscopies, 5 bowel ultrasounds, and 1 MRI or CT. In 2 out of 6 patients (33.3%), we were able to exclude IBD, and, conversely, we achieved diagnosis in 4 patients (66.7%, 2 CD, 2 UC) and started IMM therapy in 2 cases. Mean DS duration was 21.5 working days (range 9–49), with a mean loss of 2.7 working days per patient.
The IBD dedicated Day Service seems to be a good, time-saving, and, consequently, cost-effective organisational model for the management of suspected IBD or need of re-evaluation because of flare or need of re-staging of an already diagnosed IBD. The IBD specialist nurse plays a pivotal role in managing and planning the Day Service, in addition to being the counsellor for those peculiar patients.