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What is Inflammatory Bowel Disease (IBD)?

IBD is a term mainly used to describe two conditions: Ulcerative colitis and Crohn's disease (NHS)affecting more than 300,000 people in the UK (Crohn's and Colitis UK)People of any age can get IBD, but it's usually diagnosed between the ages of 15 and 40 (NHS). Symptoms vary from person to person and will range from mild to severe but may also change over time, with periods of good health when you have few or no symptoms (remission) alternating with times when your symptoms are more active (relapses or ‘flare-ups’) (Crohn's and Colitis UK).

The IBD Care Model

The Gastroenterology Service based at St Mark’s Hospital, LNWUH NHS Trust led a Research Driven Improvement Project to co-design a new model of care with patients for patients. The Brian Turley Award winning project focused on redesigning the way that patients who have IBD access care and evaluation of its efficacy. Patients worked as part of a multi-disciplinary improvement team throughout on planning, monitoring, evaluation, and using quality improvement methods to shape and support this.

People who have acute IBD need fast assessment and treatment to prevent deterioration and they were waiting longer than necessary for an outpatient appointment. 61% of outpatient appointments were used by low risk patients who had well controlled disease which was in remission.

IBD patients from St. Mark's Hospital, LNWHT worked with clinicians to improve access to appointments in the hospital setting for those with acute symptoms. 

IBD patients who had well controlled symptoms, and who had low risk of a flare up in their symptoms, were consulted about and subsequently offered appointments via a telephone clinic designed to provide a check-up and to support and maintain their independence.

“Following consultation with patients, and finding that they welcomed the option of using a telephone clinic, our plan was to relieve pressure on the Outpatient Department by arranging telephone clinics for patients with stable disease. 

Uptake of the telephone clinic option was lower than we expected at first but it improved after patients had direct discussions with clinicians about it. Now the uptake is around 55%” - Dr Arebi (May 2018)

What happened as a result of the introduction of the IBD Care Model?

  • Two new pathways were created, a rapid access clinic which sees patients with acute symptoms, and a telephone clinic which is offered to patients who have do not have acute symptoms, and where IBD is in remission.
  • Patients seen by the rapid access clinic are generally seen within 14 days and hospital admissions have been avoided.
  • Telephone Clinic use improved from 14% in 2017 to 55% in 2018 among patients in remission
  • 90% of patients are extremely satisfied with their IBD care in Gastroenterology, and average waiting times for appointments fell from 12.5 to 7.6 weeks.