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IBD inpatient care audit - round one 2007

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The UK IBD Audit is the first UK-wide audit performed within gastroenterology. The 1st Round of the UK Inflammatory Bowel Disease Audit was conducted from September 2006 to December 2006.

Key messages

  • Multidisciplinary team working functions well with timetabled meetings between gastroenterologists and surgeons in 74% of sites. Joint or parallel medical-surgical clinics occur in only 47%. Comment: IBD MDT meetings should occur regularly at all sites.
  • Hospitals vary considerably in their yearly inpatient activity in IBD; median (Interquartile range [IQR]) 50 (25-105) range 1-481 for Ulcerative Colitis and 61 (30-111) range 2-609 for Crohn’s Disease. Comment: some smaller hospitals may need to interact with larger ones to provide a comprehensive inpatient IBD service.
  • 44% of sites have no IBD clinical nurse specialist(s). Amongst those with specialist nurses, the median number of sessions dedicated to IBD care is 6 per week. Comment: IBD clinical nurse specialist(s) service needs to be expanded to include all sites caring for patients with IBD.
  • 33% of sites did not have a dedicated gastroenterology ward (medical or surgical). Comment: a dedicated gastroenterology ward or ward area should be identifiable at each site.
  • There are not enough toilets with a median 4.5 beds per toilet. Comment: there should be a maximum of 3 beds per toilet.
  • Provision of dietetic services is poor with a median of 2 (IQR 0-5) sessions per week dedicated to gastroenterology. Comment: IBD patient surveys show dissatisfaction with the lack of dietetic services. There needs to be improvement in the provision of these services.
  • Ileo-anal pouch procedures are performed in most sites (72%) but the volume of surgery is low (median 4 [IQR 2-7] per year). Comment: hospitals with a low volume of pouch surgery should consider referring to hospitals with a larger volume of pouch surgery.
  • Only 34% of sites have a searchable IBD database. Comment: Provision of databases need to improve across the UK to facilitate patient care (e.g. colorectal cancer surveillance, immunosuppressive therapy monitoring) and audit
  • Open forum or other meetings with patient groups are uncommon in the UK with only 30% of sites involved in these. Comment: IBD teams should be encouraged to set up meetings with patient groups, perhaps on a regional basis.
  • Only 21% of sites have pathways for direct access to psychological support. Comment: direct referral pathways should be available for IBD teams to refer directly to psychological support services.