Poster (15W153)

Obstacles in patient flow and a review of the infliximab infusion protocol for IBD patients in a tertiary children’s hospital.

Author(s)

Flanagan M1, Kiernan S1 & Hussey S1-3

Department(s)/Institutions

1Department of Paediatric Gastroenterology, Our Lady’s Children’s Hospital Crumlin, Dublin. 2Academic Centre for Paediatric Research, School of Medicine and Medical Science, UCD. 3National Children’s Research Centre, Crumlin, Dublin 12.

Introduction

Our Lady’s Children’s Hospital, Crumlin is the national referral centre for paediatric inflammatory bowel disease (PIBD). Approximately 100 patients are newly diagnosed with PIBD each year in Ireland. Biologic agents such as infliximab are indicated for the treatment of severe IBD but infusions are associated with a significant length of stay for patients on infusion days.

Aims/Background

To study the impact of potential timesaving interventions (prior laboratory testing, advanced prescription writing and advanced infusion preparation) on duration of stay for infliximab infusions.

Method

Over a 1 month period (23/3/15-17/4/15) patients were asked to have bloods performed within 7d of their forthcoming infusion. Doctors were advised to prescribe infliximab 48h in advance of patients’ infusions. Pharmacists were advised to prepare the infusions in advance of blood results or clinical review. A retrospective study of all infliximab infusions over a 5w period (20/4/15-22/5/15) was performed. Chart review was performed for each patient. The previous and subsequent infusions to the study timeframe infusion were analysed for comparison. Statistical analysis was performed using Excel data-tools.

Results

A total of 55 infliximab infusions were administered throughout the study timeframe, of which 54 charts were reviewed. 78% had CD and 22% UC. Seventeen percent of patients were on induction infusions versus 83% on maintenance therapy. The average times were as follows: admission to IVC insertion - 57m; admission to infusion - 3h 8m; total length of stay -7h 5m. Forty four percent of patients had paired blood tests performed, of which there was no difference in absolute neutrophil counts. The combined interventions showed a reduction in the time taken from admission to infusion commencing by 1h 9m and in the length of stay by 1h 8m. The most time efficient patient group were those who had prior bloods performed (length of stay 6h 32m, time to infusion 2h 36m). The effects of these interventions waned with time with an increase in length of stay and time to infusion of 8m. For subsequent patient infusions the shortest length of stay was for patients who had bloods performed immediately prior to infusion (6h 51m) compared to those who had paired bloods (7h 46m) or prior bloods (7h 35m) performed.

Conclusions

This study shows that simple interventions such as advanced prescription writing, advanced infusion preparation and, to a lesser extent prior, phlebotomy can reduce hospital times by over 1h. A prospective validation study is ongoing to ensure efficient patient flow for our IBD patients.