Inpatient care and inpatient experience
of young people with ulcerative colitis in
the UK
[Presenter / title]
[Date of presentation]
Introduction to the IBD programme
‘Improving the care of people with IBD’
Five elements, 2012–2014
1. Inpatient care (1 Jan – 31 Dec 2013)
Assesses the treatment that a patient receives when admitted to hospital. Each hospital participating in
the audit collects information on the first 50 patients admitted with ulcerative colitis in 2013.
2. Inpatient experience (1 Jan 2013 – 31 Jan 2014)
Assesses the quality of patient care. Each patient included in the inpatient care audit is given a
questionnaire when they leave hospital. They can comment on the care that they received and how this
made them feel.
3. Biological therapy audit (continuous audit)
Collects information about treatment, delivery, disease activity and quality of life in patients who are
prescribed infliximab or adalimumab for IBD.
Introduction to the IBD programme
‘Improving the care of people with IBD’
Five elements, 2012–2014
4. Organisational audit and quality improvement tool
IBDQIP (1 Feb – 31 March 2014)
A web-based self-assessment that enables hospitals to measure their organisation of care compared with
national service standards. The tool identifies areas for improvement and facilitates change.
5. Quality improvement: peer support visits
A series of visits where hospitals are paired up and meet to compare results and identify methods for
improving the quality of care for patients. The IBD programme team supports the clinical teams to share
best practice and explores new ways of working.
Methodology
•
•
•
•
Prospective patient identification
Ulcerative colitis (UC)
Reduced dataset
Up to 50 audited admissions per site
Inclusion criteria
Exclusion criteria
Patients admitted for treatment or
surgery for UC (including newly diagnosed
Primary reason for admission was not
for treatment of UC
patients)
Patients any age
A day case (for an infusion, endoscopy or day
surgery procedure)
Patients admitted for longer than
24 hours
Multiple admissions included
If the patient stayed overnight but was
discharged within 24 hours of admission
Participation in inpatient care
•
•
•
•
•
1 January 2013 – 1 December
2013
96% (24/25) specialist paediatric
centres in the UK
First time audit was available to a
number of smaller-volume
paediatric services that may
admit patients with UC
Total 32 sites
298 admissions audited
•
[Your site’s number of admissions]
Key indicators for inpatient care
Your site level data for this table can be found in your local site report (Section 2, Table 3)
Key indicators round 4
National results
Your site results
Previous admission in the past 2 years
58% (70/121)
% (n/N)
Seen by a paediatric IBD nurse during
admission (among emergency admissions)
73% (135/186)
% (n/N)
Stool samples sent for SSC and CDT
SSC:
68% (106/155)
CDT:
61% (95/155)
SSC:
% (n/N)
CDT
% (n/N)
SSC:
8% (9/106)
CDT:
6% (6/95)
SSC:
% (n/N)
CDT:
% (n/N)
(among emergency and planned admissions for active
UC and restricted to first admission only)
(among emergency admissions where the patient
had diarrhoea)
Positive stool sample
Key indicators for inpatient care
Your site level data for this table can be found in your local site report (Section 2, Table 3)
Key indicators round 4
National results
Your site results
Nutritional screening during admissiona
40% (119/298)
% (n/N)
Seen by a dietitian during admissiona
50% (141/282)
% (n/N)
Prophylactic heparin prescribed
7% (19/262)
% (n/N)
Non-elective surgery
26% (6/23)
% (n/N)
Elective surgery
46% (16/35)
% (n/N)
55% (95/172)
% (n/N)
(excluding elective surgical admission)
Surgery undertaken
laparoscopically
Recording of PUCAI score on day 1 in
emergency admissionsa
a Excludes from
the denominator admissions that were not applicable to the question
Key indicators for inpatient care
Your site level data for the first item below can be found in Section 2, Table 3 in your local site report.
The remaining 3 items can be found within the national data table (from page 21). Individual question
numbers are provided below
Key indicators round 4
National results
Your site results
Medication(s) not started or increased in the
clinic appointment prior to admission.
Includes: 5‐ASA, steroid, topical or
immunosuppressant therapy (among admissions
54% (56/103)
% (n/N)
Bone protection prescribed in those
discharged home on steroids (Q5.1.1)
32% (65/202)
% (n/N)
No steroid-sparing therapies tried for
patients on steroids >3 months (Q6.2.2 d)
16% (12/74)
% (n/N)
No treatment provided for iron deficiency
52% (89/171)
% (n/N)
where the patient had active UC at their last clinic
appointment and were not admitted to hospital)
(Q6.3.3)
Outcomes of treatment escalation in UC
Inpatient care audit recommendations
1. All young people with UC should have their disease activity assessed (including
use of PUCAI), and treatment should be initiated or escalated in those with active
disease during all points of clinical interaction. Early intervention may prevent
admission or reduce the need for surgery.
2. All patients with diarrhoea should have their stools sampled for both standard
stool cultures and Clostridium difficile toxin testing.
3. All patients should have nutritional assessment on admission.
4. All patients on steroids for longer than 3 months should be considered for steroidsparing agents.
Inpatient care audit recommendations
5. New therapies for paediatric UC should be actively investigated in high-quality
clinical trials to tackle the number of patients who need hospital admission,
including those who require surgery for failure of medical therapy. It is worthy of
note that none of the patients in this category who were included in this audit
were recruited to a clinical trial.
6. Anaemia should be actively investigated, and the cause should be identified and
treated appropriately.
7. Further national audit in IBD should be commissioned.
Participation in inpatient experience
•
•
•
•
•
•
1 January 2013 – 31 January
2014
96% (24/25) from specialist
paediatric centres in the UK
First time audit was opened up
to a number of smaller-volume
paediatric services that may
admit patients with UC
32 sites in this round
1687 questionnaires returned in
total (1550 included in national analysis)
Your site’s number of
questionnaires returned
Key indicators for inpatient experience
Key indicators round 4
National results
Your site results
Overall how would you rate the care you
received?
Excellent =
68% (45/66)
Excellent =
% (n/N)
Did you have confidence and trust in the
doctors treating you?
Yes, always =
89% (59/66)
Yes, always =
% (n/N)
Did the patient receive a visit from a
specialist nurse?
No =
17% (11/65)
No =
% (n/N)
Was the patient visited by a dietitian?
No =
61% (40/66)
No =
% (n/N)
Were you ever in pain?
Yes =
80% (52/65)
Yes =
% (n/N)
Do you think the hospital staff did everything Yes, definitely =
75% (39/52)
the could to control your pain?
Yes, definitely =
% (n/N)
Key indicators for inpatient experience
Key indicators round 4
National results
Your site results
In your opinion how clean was the hospital
room or ward you were in?
Very clean =
76% (50/66)
Very clean =
% (n/N)
How would you rate how well the doctors
and nurses worked together?
Excellent =
55% (36/66)
Excellent =
% (n/N)
No =
Did a member of staff tell you about any
danger signals you should watch out for after 20% (13/65)
you went home?
No =
% (n/N)
Do you feel that you received enough
information from the hospital on how to
manage your condition after your discharge?
Yes, definitely =
65% (43/66)
Yes, definitely =
% (n/N)
Would you recommend this hospital to your
family and friends?
Yes, definitely =
83% (55/66)
Yes, definitely =
% (n/N)
Satisfaction of services among
adolescents/non-adolescents
Paediatric service
Adult service
<13 years
Aged 13–18
Aged 13–18
19+ years
Overall rating of care received
Excellent
Very good
Good
Fair
Poor
(N=29)
62% (18)
35% (10)
3% (1)
0% (0)
0% (0)
(N=37)
73% (27)
19% (7)
5% (2)
3% (1)
0% (0)
(N=46)
26% (12)
41% (19)
28% (13)
4% (2)
0% (0)
(N=1429)a
47% (678)
33% (474)
12% (166)
6% (85)
2% (26)
Would you recommend this hospital to your family and
friends?
Yes, definitely
Yes, probably
No
(N=29)
(N=37)
(N=46)
(N=1419)b
83% (24)
17% (5)
0% (0)
84% (31)
16% (6)
0% (0)
46% (21)
44% (20)
11% (5)
63% (889)
30% (421)
8% (109)
In your opinion, was the ward you stayed on suitable for
a person of your age?
Yes, definitely
Yes, probably
No
Not sure
(N=0)
(N=37)
(N=45)
(N=0)
0% (0)
0% (0)
0% (0)
0% (0)
46% (17)
24% (9)
24% (9)
5% (2)
20% (9)
27% (12)
47% (21)
7% (3)
0% (0)
0% (0)
0% (0)
0% (0)
a9
missing responses; b 19 missing responses
Patient experience across core domains
of acute inpatient care
Inpatient experience quotes
Inpatient experience quotes
Inpatient experience recommendations
1. All UC inpatients should receive input from specialist multidisciplinary teams with
experience of managing such complex disorders. This will maximise the
opportunity for provision of consistent and coordinated care.
2. Local IBD teams should consider whether the general nursing staff have sufficient
awareness and knowledge of IBD, and initiate appropriate educational
interventions and care pathways to support high‐quality nursing. The routine
involvement of specialist IBD nurses in the day‐to‐day care of IBD patients at
ward level is seen as a potential driver to improve the overall experience of
nursing care.
3. All admitted patients with active UC require routine documentation of nutritional
intake and weight. Nursing care plans should identify nutrition as a key element of
day‐to‐day care. Food provided should be appropriate to patients’ dietary needs.
Standard A5 of the IBD standards1 states that access to a dietitian should be
available to all IBD patients.
1 IBD
Standards Group. Standards for the healthcare of people who have inflammatory bowel disease (IBD Standards), 2013 update.
www.ibdstandards.org.uk
Inpatient experience recommendations
4. Ward medical and nursing teams should review their local policies and current
practice with regard to the frequency and effectiveness of pain assessment and
provision of analgesia.
5. Discharge policies for IBD patients require local review to ensure that patients
receive high-quality pre‐discharge information regarding medication, self‐care and
follow‐up plans. In particular, improvements are needed in the provision of
information about potential drug side effects and the warning signs of which to
be aware after discharge.
Your three key areas for local change
Local key area
identified
What action is needed Who will be
to facilitate this
responsible?
change?
1. Treatment of
anaemia
Write local treatment
algorithm and
circulate to MDT
2.
3.
How and
when will
you review
this action?
Consultant
Sep 2014
gastroenterologist
and IBD nurse
Acknowledgements
Thank you to all the hospital-based staff who
contributed towards case note retrieval and data
collection, and distributed the inpatient experience
questionnaires.
For further information, contact
ibd.audit@rcplondon.ac.uk