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P181 Triage straight to test (tSTT) improves early diagnosis of inflammatory bowel disease (IBD)

S. Jora

Barts Health, Gastroenterology, London, UK

Background

It is well known that there is a significant delay in diagnosing IBD. On average it takes 4–9 months to diagnose Crohn’s disease (CD) and 4 months for ulcerative colitis (UC)1. Barts Health NHS Trust in the UK is one of the pioneer hospitals in establishing Triage Straight to Test (tSTT) for patients with lower gastrointestinal (GI) symptoms. The aim of the programme is to reduce the time from a primary care physician (General practitioner) referral to the secondary care to achieve a definitive diagnosis. This minimises the number of outpatient appointments required and makes an efficient use of medical and surgical resources. We aim to study whether tSTT pathway reduces the time to diagnose IBD.

Methods

Patients with lower GI symptoms were referred to a specialist tSTT triage nurse, where they were allocated into two pathways—routine (18-week wait) and upgraded (2-week wait). A comprehensive telephone assessment, calprotectin levels and clinical information provided by the GP would determine the route and urgency of the investigation. Pathologies such as cancer, IBD and polyps were treated via a predefined management pathway. The patients with a benign disease were discharged and in some cases called for a follow-up appointment.

Results

During July 2013 to November 2019 a total of 2270 patients have been triaged. One hundred and one (4.45%) patients were diagnosed with IBD, where 36 patients (36%) were histologically characterised as CD and the other 65 patients (64%) were diagnosed as UC. The mean age of diagnosis for both CD and UC patients was 40 years (range 16–79). The average time from referral to endoscopy on tSTT pathway was 22.6 days for upgraded referrals and 43.5 days for non-upgraded. There is a significant difference in time to diagnosis between routine and upgraded pathways (22.6 days vs. 43.5 days, p < 0.001).

Conclusion

The above data suggest a significant reduction in time to diagnose IBD through tSTT pathway. Early diagnosis ensures that the patient receives an early customised care and avoids disease-related complications. It also means that the NHS resources can be used wisely by avoiding a delay in getting outpatient consultant appointments.