National audit of adult IBD service provision Organisational audit [Enter name of presenter] [Enter date of presentation]

Introduction to the IBD programme ‘Improving the care of people with IBD’ Five elements, 2012–2014 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 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 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 Services were advised to meet as a multidisciplinary team to collect data into an online web tool Data collected was to reflect the IBD service ‘as at’ 31 December 2013 The dataset was mapped to the IBD Standards As soon as all data was entered onto the web tool and ‘submitted’, instant results were available in a results dashboard Online action planning (linked to results) was also available

Participation in the organisational audit 1 February 2014 – 31 March 2014 87% (142/163) adult trusts / health boards that were eligible to take part 173 hospital sites took part

Key indicators Key indicators round 4 National results Your site level data for this table can be found in your local site report (Section 2, Table 1) Key indicators round 4 National results Your site results Standard A1 – The IBD team Median (IQR) number of whole-time equivalent (WTE) IBD nurses on site 1 (0.6, 1.8) Median (IQR) number of WTE dietitians allocated to gastroenterology (0.1, 1) Standard A8 – Inpatient facilities Sites with an identifiable gastroenterology ward 95% (165/173) Sites with at least one toilet per three IBD patients 27% (47/173)

Key indicators continued Your site level data for this table can be found in your local site report (Section 2, Table 1) Key indicators round 4 National results Your site results Standard A10 – Inpatient care Sites with guidelines for the management of acute severe UC 84% (146/173) Standard A12 – Arrangements for the care of children and young people Site with a transitional care service for young people to support their transfer to adult services 53% (92/173) Standard C2 – Rapid access to specialist advice Sites where relapsing patients can be seen for specialist review within 7 days 74% (128/173)

Key indicators continued Your site level data for this table can be found in your local site report (Section 2, Table 1) Key indicators round 4 National results Your site results Standard D2 – Education for patients Sites where educational opportunities are provided for patients and their families 48% (83/173) Standard E1 – Register of patients under the care of the IBD service Sites with a searchable database or registry of adult IBD patients 36% (62/173) Standard E3 – Participation in audit Sites where patients undergoing ileal pouch surgery are entered into the pouch registry 66% (86/130)

Recommendations All IBD services should be staffed in line with IBD Standard A1 1.5 WTE IBD nurse per 250,000 population 0.5 WTE dietitian allocated to gastroenterology Regular, timetabled MDT meetings should take place, preferably weekly. Attended by members of the IBD team as outlined in IBD Standard A3. All patients experiencing a relapse should have access to specialist review within 5 working days (IBD Standard A11). There should be a policy/protocol for transitional care and a named coordinator responsible for preparation and oversight of transition (IBD Standard A12). Toilets facilities should be provided as outlined in IBD Standard A12 (floor-to-ceiling partitions, full-height doors and good ventilation. There should be a minimum of one toilet per three IBD beds.

Recommendations cont. IBD services should be providing education opportunities for patients and their families, that include: disease education, treatment options and self-management strategies (IBD Standard D2) Every IBD service should maintain a local register of all patients diagnosed with IBD (IBD Standard E1) Outcomes of all pouch surgery, should be entered onto the national pouch registry (IBD Standard A3) The IBD service should have defined access to a psychologist and/or counsellor with an interest in IBD (IBD Standard A2)

Your three key areas for local change Local key area What action is needed to facilitate change? Who will be responsible? How and when will you review this action? Educational opportunities should be provided for patients and their families, as stated in IBD Standard D2 Assign a named member of staff the responsibility for developing an education programme for patients / family IBD nurse At an MDT meeting in Jan 2015

Acknowledgements Thank you to all the hospital-based staff who contributed towards case note retrieval and data collection. For further information, contact: ibd.audit@rcplondon.ac.uk