Inpatient care and inpatient experience
of adults 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 explore 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
95% (154/162) adult trusts/
health boards that were eligible
to take part
190 hospital sites took part
4359 admissions were 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
Mortality – death during admission
0.85% (37/4359)
% (n/N)
Previous admission in the past 2 years
31% (854/2778)
% (n/N)
Active UC admissions and no UC medication
on admission (excludes new diagnoses)
11% (352/3065)
% (n/N)
Seen by IBD nurse (among emergency admissions)
49% (1657/3410)
% (n/N)
Stool samples sent for SSC and CDT
SSC:
80% (2060/2565)
CDT:
76% (1940/2565)
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)
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
Positive stool sample
SSC:
3% (57/2060)
CDT:
4% (79/1940)
SSC:
% (n/N)
CDT:
% (n/N)
Nutritional screening during admissiona
82% (3566/4359)
% (n/N)
Seen by a dietitian during admissiona
40% (1449/3635)
% (n/N)
Prophylactic heparin prescribed
90% (3560/3952)
% (n/N)
Ciclosporin:
22% (268/1226)
Anti‐TNFα:
42% (519/1226)
Ciclosporin:
% (n/N)
Anti‐TNFα:
% (n/N)
(excluding elective surgical admission)
Ciclosporin/anti‐TNFα prescribed following
failure to respond to corticosteroids
a Excludes from
the denominator admissions that were not applicable to the question
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
Response to ciclosporin / anti-TNFα
treatmenta
80% (627/780)
% (n/N)
Surgery during admission among
non‐elective surgical admissions
12% (442/3784)
% (n/N)
Bone protection prescribed when discharged 74% (2553/3448)
home on steroids
Medication(s) not started or increased in the
clinic appointment prior to admission.
Includes: 5‐ASA, steroid, topical or
immunosuppressant therapy
42% (556/1329)
(among admissions where the patient had active UC at their
last clinic appointment and were not admitted to hospital)
a Response to
treatment is defined as not having had surgery and not having died during admission
% (n/N)
% (n/N)
Key indicators for inpatient care
Your site level data for this table can be found in your local site report, within the national data table
(from page 23). Individual question numbers are provided below
Key indicators round 4
National results
Your site results
No steroid-sparing therapies tried for
patients on steroids >3 months
22% (151/684)
% (n/N)
56% (783/1406)
% (n/N)
(National data table Q6.2.2 d)
No treatment provided for iron deficiency
(National data table Q6.3.3)
Outcomes of treatment escalation in UC
Inpatient care audit recommendations
1. All outpatients with UC should have their disease activity accurately assessed (eg
using symptoms and faecal calprotectin), and treatment should be initiated or
escalated in those with active disease. Early intervention may prevent admission.
2. All patients with a new diagnosis of UC, those for whom the use of anti‐TNFα is
considered and those requiring additional information should be seen by an IBD
nurse during admission.
3. IBD services should ensure that inpatient IBD care provided by the IBD nurse is
appropriately resourced in line with IBD Standard A1 (1.5 whole‐time equivalent
nurse per 250,000 population).
4. All IBD patients admitted to hospital should be weighed and their nutritional
needs assessed, in line with IBD Standard A10.
5. Bone protection should be prescribed to all patients with UC who receive
corticosteroids.
Inpatient care audit recommendations
6. Heparin should be given to all patients for whom it is not contraindicated, to
reduce the risk of thromboembolism.
7. All patients on steroids for longer than 3 months should be considered for
steroid‐sparing agents such as azathioprine.
8. Anaemia should be actively investigated, and the cause should be identified and
treated appropriately.
9. Further national audit in IBD should be commissioned.
Participation in inpatient experience
•
•
•
•
1 January 2013 – 31 January
2014
154/162 (95%) trusts/health
boards
190 hospitals
1687 questionnaires returned
(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 =
47% (690/1475)
Excellent =
% (n/N)
Did you have confidence and trust in the
doctors treating you?
Yes, always =
75% (1098/1470)
Yes, always =
% (n/N)
Did the patient receive a visit from a
specialist nurse?
No =
28% (417/1471)
No =
% (n/N)
Was the patient visited by a dietitian?
No =
62% (915/1476)
No =
% (n/N)
Were you ever in pain?
Yes =
78% (1154/1478)
Yes =
% (n/N)
Do you think the hospital staff did everything Yes, definitely =
66% (763/1148)
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 =
62% (914/1473)
Very clean =
% (n/N)
How would you rate how well the doctors
and nurses worked together?
Excellent =
40% (584/1472)
Excellent =
% (n/N)
No =
Did a member of staff tell you about any
danger signals you should watch out for after 33% (477/1466)
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 =
47% (683/1454)
Yes, definitely =
% (n/N)
Would you recommend this hospital to your
family and friends?
Yes, definitely =
62% (910/1465)
Yes, definitely =
% (n/N)
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