NO003 IBD nurses as integral part of a multidisciplinary IBD team: prospective study on view on patient outcomes
Coenen S.*1, Weyts E.1, Geens P.1, Vermeire S.1, Ferrante M.1, Noman M.1, Ballet V.1, Vanhaecht K.2, Van Assche G.1
1UZ Leuven, Gastroenterology, Leuven, Belgium 2UZ Leuven, Quality, Leuven, Belgium
Inflammatory bowel diseases (IBD) are chronic gastrointestinal conditions with great impact on patient's social and professional life. Information, education and empowerment will help to optimize and ameliorate disease outcomes. In this process IBD nurses play a key role. They support the patient and facilitate prompt recognition of symptoms. In this way, IBD nurses can accomplish better compliance, more early intervention during flares and as a consequence, improve patient outcomes. We prospectively investigated the effect of IBD nurses on improvement of quality of patient's care.
In Sep 2016, a second IBD nurse joined the multidisciplinary IBD team in our tertiary referral center. In order to standardize assessments and measurements, all contacts (phone, e-mail and personal contacts) were prospectively collected and in detail by using a standard record. Patient characteristics, type of contact and interventions performed by the IBD nurse were categorized in the record and outcomes were reported.
During Sep and Oct 2016, 703 patient contacts were recorded by the two IBD-nurses (43% male, median age 35 years, 77% Crohn's disease; 65% of patients on biologicals). The vast majority of nurse-patient contacts were phone calls (64%), a minority involved personal contacts (28%) and e-mails (9%). Most of the contacts of the IBD nurse were assigned to providing disease information (24%), to the planning of procedures and consultations (21%), to administration (12%) and to the follow-up on medication (11%). In addition 11% of the patients contacted the IBD nurses for flare management, 9% for psychosocial support, 7% for the start of new therapy and 6% for education on therapy. Most of the interventions performed by the nurses involved comforting patients (22%), calling patients for follow-up (19%), for blood or stool sampling (15%) and planning an urgent outpatient visit (9%). Beside, information brochures were provided during 5% of the contacts, medication was initiated for 5% of the patients and 4% of the patients were referred to the general practitioner. By planning 75 urgent outpatient visits, the IBD nurses intervened earlier during a flare and as a result 17 emergency room visits could be avoided in this 2-month period only. Another 92 outpatient appointments could be avoided through counseling by phone and for 10 patients education and follow-up on therapy resulted in better compliance.
Standardized measurement of outcomes is a “hot topic” in today's clinical practice. Prospective and standardized reporting of each nurse-patient contact allows us to measure important patient outcomes. In this way variability in reporting can be reduced, and the care can rapidly be monitored and improved.