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P355 A structured care pathway improves quality of care for acute severe ulcerative colitis

Neary B., Doherty G., Rafter N., Gibson D.

St Vincent's University Hospital, Gastroenterology, Dublin, Ireland

Background

The UK IBD Audit 2014 identified important deficiencies in the care of hospitalised patients with Acute Severe Ulcerative Colitis (ASUC). Our aim was to assess whether the introduction of a structured inpatient care pathway improves adherence to the UK IBD Audit guidelines and improves patient care.

Methods

A retrospective review of all patients admitted with ASUC between January 2010-November 2011 identified areas for improvement of inpatient care. As a result, a structured pathway was introduced to be used for all admissions for ASUC. A further review of admissions with ASUC was conducted following the introduction of an integrated care pathway from July 2015-September 2016. A comparison was made of key outcomes and quality measures at baseline and following introduction of the care pathway. Comparison was also made with the UK IBD Audit, 2014. Key outcomes measured included length of stay, time till seen by GI team, stool C&S and C Difficile being sent, endoscopy during admission, steroid prescription, bone protection, VTE prophylaxis, dietician referral, IBD nurse referral, weight recording, stool chart recorded, PFA on admission and investigation of anaemia

Results

A total of 67 patients with a primary discharge diagnosis of colitis were identified. 26 patients were excluded (elective admission for surgery or endoscopy). 41 patients were considered eligible for further study. The outcomes in this cohort were compared to those in the January 2010-November 2011 study and later to the UK IBD Audit 2014 (Fig. 1).

Figure 1

M:F ratio 25:16 (61%:39% vs 68%:32%). Median age was 32 (±13.8) vs 47 (±17.68). Notable results included a statistically significant reduction in hospital length of stay (mean 7 days vs 13 days, log rank p<0.001). There was also a significant reduction in time to administration of VTE prophylaxis (log rank p<0.0001). Otherwise, there were improvements in patients who:

1. Were seen by a specialist gastrointestinal team within 1 day (87.8% vs 78.9%)

2. Had stool samples sent for culture, sensitivity and C Difficile (85.4% vs 76.9%).

3. Were prescribed bone protection (97.6% vs 73%).

4. Were seen by an IBD specialist nurse during admission (63% vs 10%).

5. Had anaemia evaluated (70.6% vs 28.6%).

6. Had a CRP measured on admission (98% vs 61%).

Conclusion

The introduction of a structured care pathway for ASUC resulted in an overall improvement in inpatient care and adherence to UK IBD Audit recommendations, with a significant reduction in hospital length of stay.