NO002 Introduction of an inflammatory bowel disease nurse flexible sigmoidoscopy clinic improves patient care by initiating earlier treatment and saves clinic slots
H. Johnson*, S. Weaver, S. McLaughlin
Royal Bournemouth Hospital, Department of Gastroenterology, Bournemouth, United Kingdom
It is a marker of quality to be able to respond promptly and effectively to a patient with inflammatory bowel disease (IBD) at a time of flare. Many patients who contact the IBD helpline with flare symptoms require a flexible sigmoidoscopy (FS) for accurate assessment. These are usually performed on generic lists where follow-up to consider a new treatment plan is arranged resulting in delays in treatment and creating pressure on clinic slots. An experienced IBD nurse prescriber (IBDN) was trained in FS with the aim to endoscopically assess patients and potentially start new treatment the same day.
Aim: to report the outcomes from the first 2 years of the IBD nurse endoscopist clinic
Records were reviewed of all patients attending the IBDN FS clinic. We evaluated the time from referral to FS, diagnoses, demographics, and outcomes.
In total, 410 patients underwent a FS with the IBDN.
195 (47.6%) patients referred for rectal bleeding did not have IBD.
215 (52.4%) had a known diagnosis of IBD; 152 (70.7%) ulcerative colitis; and 63 (29.35%) Crohn’s disease; 130 (60.5%) were female; mean age: 48 (range 16–88).
Referral origin: 76 (35.3%) IBD Helpline; 58 (27%) IBD Consultant clinic; 39 (18.1%) IBDN Clinic; 27 (12.6%) other medical clinic; 11 (5.1%) in-patient; 4 (1.9%) primary care.
FS outcome: 55 (25.6%) commenced azathioprine; 47 (21.9%) started oral prednisolone; 38 (17.7%) commenced 5 ASA therapy; and 19 (8.8%) no changes to their care; in 41 (19.1%), FS was performed to assess need for or response to biological therapy; the 11 (5%) in-patients returned to the ward; 4 (1.9%) diagnosed with acute severe ulcerative colitis.
Mean time from referral to test: 7 days, (range 0–28).
In total, 137 clinic slots were saved over 2 years; 76 directly from the helpline, avoiding an urgent clinic slot; following FS, 51 (23.7%) patients were discussed at the next IBD MDT, saving a follow-up clinic slot. At the MDT the endoscopy findings were reviewed and discussed and appropriate treatment confirmed with the patient in the IBD telephone clinic; 10 (4.7%) patients were referred direct to the day unit to commence biological therapy following confirmation of active disease at FS as per the treatment plan from the consultant referral.
The IBDN FS clinic reduced the time interval between developing symptoms and starting a new treatment plan for IBD patients. The skilled prescribing IBDN endoscopist made changes in 91.2% at the time of the FS. The relatively small number of patients starting 5-ASA therapy suggests this had been optimised before FS, suggesting patients attending the IBDN FS clinic had moderate-to-severe IBD. The introduction of the IBDN FS clinic also led to a reduction in demand on outpatient clinic slots.