P378 The outcomes of a clinical care pathway for inflammatory bowel disease surgery
A. Platt*1, A. Lightner2, R. Jacobs1, D. Sagar1, W. van Deen1, T. Hommes1, S. Reardon3, J. Sack3, D. Hommes1
1UCLA Centre for Inflammatory Bowel Diseases, Department of Digestive Diseases, Los Angeles, California, United States, 2Mayo Clinic College of Medicine, Division of Colon and Rectal Surgery, Rochester, Minnesota, United States, 3UCLA, Department of Colorectal Surgery, Los Angeles, California, United States
Inflammatory bowel disease (IBD) patients undergoing surgery are being discharged earlier because of increased financial pressure on hospitals, shifting postoperative care towards an outpatient setting. We introduced a care pathway for IBD surgery designed to tightly monitor patients at home using tele-monitoring tools. The measured health outcomes included pain, wound healing, bowel function, and quality of life (QoL), and additionally, allowed for on-demand eConsulting between patient and provider. Here we report our first outcomes.
Through this 4-week programme, we developed a cohesive pathway focused on heightened connectivity and accurate assessments via tele-monitoring. In addition, we established optimal care delivery by streamlining transition back to GI care. Data was collected from patient reports, clinic visit summaries, and the EMR. During the pathway, pain was measured with a 01–0 Likert scale; wound healing was assessed through wound photos; bowel function was assessed with ostomy output and stool frequency; and QoL was measured with the short IBD questionnaire (sIBDQ).
In total 54 patients, who underwent 70 surgeries, were enrolled. Mean age was 38 years (197–4) and 50% were male. Of all surgeries, 49% (n = 34) were for CD, 47% (n = 33) for UC, and 4% (n = 3) for indeterminate. Surgeries involved bowel resection (64%), ostomy formation/reversal (64%), and other procedures (39%), including fistula repair and adhesiolysis. Patients were connected to providers and monitored accurately through a series of tele-monitoring eTools: mean number of wound photos sent was 3 (range 0–11); average daily stool frequency was 6, whereas average ileostomy output was 930 mL; an initial pain score of ≥ 5 was reported in 34% of patients, and an average 2-point decrease was observed during the programme. Of note, 30-day ED rates were higher in high-pain vs low-pain patients (33% vs 22%). Finally, care delivery was optimised with follow-up visits: higher GI clinic follow-up rates were observed in compliant vs non-compliant patients (65% vs 49%). For those who had a 30-day GI follow-up, average QoL was 49 (SD = 16), as compared with 42 (SD = 14) for those who did not.
Increased connectivity and accurate tele-monitoring are helpful in identifying patients who may be at risk for ED visits during their recovery period. Moreover, increased GI follow-up visits in highly compliant patients may indicate the benefit of postoperative communication in care delivery; the higher QoL scores in these patients may further support this notion. Thus, coordinated care for surgery might be an effective way to manage and monitor IBD patients postoperatively and transition them back to the GI clinic for long-term medical treatment.