Inpatient care and inpatient experience of adults with ulcerative colitis in the UK [Presenter / title] [Date of presentation]

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.

•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.

•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.

•Quality improvement: peer support visitsA 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 patients)

Primary reason for admission was not for treatment of UC

Patients any age A day case (for an infusion, endoscopy or day surgery procedure)

Patients admitted for longer than 24 hours

If the patient stayed overnight but was discharged within 24 hours of admission

Multiple admissions included

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

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 (among emergency and planned admissions for activeUC and restricted to first admission only)

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(among emergency admissions where the patienthad diarrhoea)

SSC: 80% (2060/2565)CDT:76% (1940/2565)

SSC:% (n/N)CDT% (n/N)

Your site level data for this table can be found in your local site report (Section 2, Table 3)


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 (excluding elective surgical admission)

90% (3560/3952) % (n/N)

Ciclosporin/anti TNFα prescribed following ‐failure to respond to corticosteroids

Ciclosporin:22% (268/1226)Anti TNFα:‐42% (519/1226)

Ciclosporin:% (n/N) Anti‐TNFα:% (n/N)

a Excludes from the denominator admissions that were not applicable to the question

Key indicators for inpatient careYour site level data for this table can be found in your local site report (Section 2, Table 3)


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 home on steroids

74% (2553/3448) % (n/N)

Medication(s) not started or increased in the clinic appointment prior to admission. Includes: 5 ASA, steroid, topical or ‐immunosuppressant therapy(among admissions where the patient had active UC at their last clinic appointment and were not admitted to hospital)

42% (556/1329) % (n/N)

Key indicators for inpatient care

a Response to treatment is defined as not having had surgery and not having died during admission

Your site level data for this table can be found in your local site report (Section 2, Table 3)


No steroid-sparing therapies tried for patients on steroids >3 months (National data table Q6.2.2 d)

22% (151/684) % (n/N)

No treatment provided for iron deficiency (National data table Q6.3.3)

56% (783/1406) % (n/N)

Key indicators for inpatient careYour 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

Outcomes of treatment escalation in UC

Inpatient care audit recommendations1. 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 recommendations6. 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


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 the could to control your pain?

Yes, definitely =66% (763/1148)

Yes, definitely =% (n/N)

Key indicators for inpatient experience


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)

Did a member of staff tell you about any danger signals you should watch out for after you went home?

No =33% (477/1466)

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 =% (n/N)

Would you recommend this hospital to your family and friends?


Yes, definitely = % (n/N)

Key indicators for inpatient experience

Patient experience across core domains of acute inpatient care

Inpatient experience quotes

Inpatient experience quotes

Inpatient experience recommendations1. 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 recommendations4. 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 to facilitate this change?

Who will be responsible?

How and when will you review this action?

1. Treatment of anaemia

Write local treatment algorithm and circulate to MDT

Consultant gastroenterologist and IBD nurse

Sep 2014

2.

3.

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, [email protected]

mailto:[email protected]

Documents

Inpatient care and inpatient experience of adults with ulcerative colitis in the UK [Presenter / title] [Date of presentation]