Use of an integrated care pathway for Acute Severe Ulcerative Colitis improves quality
B. Neary, N. Rafter, D. Gibson, J. Sheridan, G. Doherty, H.E. Mulcahy, G. Cullen, D. Keegan, K. Byrne
Centre for Colorectal Disease, St Vincent’s Hospital and School of Medicine, University College Dublin (UCD), Ireland
The UK National IBD Audit identified important gaps in the care of hospitalised patients with Acute Severe Ulcerative Colitis (ASUC). A range of indicators of the quality of this care have thus emerged.
To assess whether the introduction of a structured care pathway for acute colitis improves quality of patient care.
A baseline review of all acute hospital admissions with ASUC from January 2010-November 2011 highlighted gaps in inpatient care. As a result, a structured pathway was introduced to be used for all admissions with ASUC. A further review of admissions with ASUC was conducted following the introduction of the 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 National 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, steroids prescribed, bone protection, VTE prophylaxis, seen by dietician, seen by IBD nurse, weight recorded, stool chart recorded, PFA on admission and investigation of anaemia.
67 patients were identified by HIPE coding with primary discharge diagnosis of colitis. 41 patients with ASUC were eligible for further study (patients admitted electively for endoscopy or surgery were excluded). Results are listed as current study/2010-2011 study/UK IBD Audit. Prescription of bone protection improved significantly (98%/73%/74%). Stool for C&S and C Difficile was sent in more patients (85%/77%/81%). A greater proportion of the patients were seen by an IBD specialist nurse during admission(63%/10%/44%). Anaemia was adequately evaluated in 71% of patients vs 29% in the previous study. Median length of stay was reduced following introduction of the care pathway (4 days vs 8days/7days)
The introduction of a structured integrated care pathway for ASUC has resulted in improvements in patient care and adherence to the UK IBD Audit guidelines, particularly with regards to IBD nurse involvement, stool sample collection, bone protection and investigation of anaemia. Use of a care pathway may also help reduce length of hospital stay.