Improving the quality of care for people with inflammatory bowel disease (IBD): results of a national audit

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© Royal College of Physicians 2015. All rights reserved. s11
Future Hospital Journal 2015 Vol 2, No 2: s11 AUDIT AND DATA SYSTEMS
Aims
The UK IBD audit aims to assess the quality of care for patients
with IBD and identify priorities for further improvements.
Methods
A fourth-round audit of inpatient care and experience of people
with ulcerative colitis (UC) was conducted between 1 January
and 31 December 2013. Hospitals that provided a service for
people with IBD prospectively audited up to 50 consecutive
admissions of people with ulcerative colitis (UC). Inclusion
criteria: primary reason for admission was for the treatment
of UC, duration of admission longer than 24 hours, any age,
admitted to any ward, multiple admissions and patients newly
diagnosed with UC. Data were collected via a web-based tool
and covered admission information, assessment of extent of
disease, medical intervention, surgical intervention, discharge
arrangements and outpatient care prior to admission. For each
audited admission, a questionnaire about inpatients’ experiences
of hospital facilities, care and treatment, staff, operations,
pain and food could be generated and given to the patient on
discharge with a freepost envelope. Alternatively, patients could
reply via the audit web tool.
Results
Data were collected on 4,359 adult patients from 190 hospitals
in the UK. Compared against three previous rounds of audit
(between 2006 and 2013), there was evidence of improvements;
reduced mortality, improved prescription of heparin and bone
protection, increased contact with an IBD nurse and a reduction
in episodes of unplanned surgery. However, there was also
evidence of poor management of care. 48% of patients admitted
were anaemic and, where anaemia was due to iron defi ciency, no
treatment was received in 56%. 60% of applicable patients did
not see a dietitian. 70% of inpatients were seen in outpatients
prior to admission but, where active disease was recorded,
standard treatments had not been started or escalated in 42% of
these cases. 12% of patients were readmitted within 30 days.
For inpatient experiences, 1550 questionnaires were analysed.
There was no signifi cant improvement in all aspects of care from
round 3. Notably, 73% of adolescents treated by a paediatric
service rated their care as ‘excellent’; in comparison, only 26%
of adolescents treated by an adult service rated their care as
‘excellent’.
Conclusions
Some improvements in inpatient care for people with UC were
identifi ed, but not for patient experiences. Aspects of IBD care
that need targeted improvement include treatment of anaemia,
provision of dietetic support, transitional care and management
of patients seen in outpatients. This could reduce the burden of
admissions to hospital.
Confl ict of interest statement
This project was managed by the Royal College of Physicians
and commissioned by the Healthcare Quality Improvement
Partnership (HQIP) as part of the National Clinical Audit and
Patient Outcomes Programme (NCAPOP). ■
Authors: Royal College of Physicians, London, UK
Improving the quality of care for people with infl ammatory
bowel disease (IBD): results of a national audit
Authors: Kajal Mortier, Aimee Protheroe and Susan Murray
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