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NO003 Proving cost effectiveness through implementation of a nurse-led inflammatory bowel disease patient advice line and virtual clinic (CHEAP)

A. Sechi*, E. Sawyer, W. Ng, S. Connor

Liverpool Hospital, Department of Gastroenterology, Liverpool, Australia

Background

In the care of patients with inflammatory bowel disease (IBD), a nurse-led IBD patient advice line (AL) and virtual clinic (VC) is increasingly being recognised as an integral part of the IBD service. The AL is a telephone and e-mail service for patients needing acute advice relating to their IBD. The VC involves the IBD specialist nurse reviewing and triaging patient investigations before a collaborative review with the IBD consultant. A subsequent plan of care is made, actioned, and communicated to the patient via phone or e-mail. The aims of this prospective audit were to evaluate the outcome of the nurse-led AL and VC and to quantify the potential financial implication to the Australian healthcare system.

Methods

Data were collected prospectively at Liverpool Hospital, a single tertiary IBD specialist referral centre in Sydney. Each outpatient occasion of service (OOS) was recorded for the AL over a period of 4 months, and for the VC over 6 months. Both periods were completed on October 31, 2015, although data collection is ongoing. An OOS was only included when it resulted in a change to patient management. Each OOS was categorised into: 


a) General practitioner consultation (GPC) avoided

b) IBD outpatient consultation (OPC) avoided

c) Emergency Department (ED) presentation or hospital admission avoided

Costs incurred for the AL and VC included both the nursing time required (mean 21 hours per week) and the gastroenterologists’ time (mean 3 hours per week). Savings were calculated based on the OOS that avoided GPC, IBD OPC, presentation to ED, and admission to hospital. Costs were benchmarked using the Medicare Benefit Schedule (MBS) and Independent Hospital Pricing Authority (IHPA) of Australia, and prices were expressed in Australian dollars (AUD).

Results

Over 4 months, 111 calls were received through the AL. Of these, 34 avoided GPC and 70 avoided IBD OPC; 6 ED presentations were avoided; and there was 1 avoided hospital admission. There were 438 VC OOS over the 6 month period. Of these, 3 avoided GPC and 400 avoided IBD OPC, and 34 ED presentations were avoided. There were no unplanned presentations to ED and no unplanned hospitalisations, and 1 patient presented to ED upon instruction. Avoidance of GPC, OPC, and ED presentations led to a projected annual cost saving of $176 350, with the projected annual costs incurred being $65 289. Thus the projected annual net cost savings were $111 061.

Conclusion

Specialised IBD nurse-led AL and VC improves IBD patients’ access to services, as well as overall care, and it reduces healthcare costs. This finding highlights the importance of a proactive multidisciplinary approach in optimising the care of patients with IBD.