PTH-109 Inequality of provision of inflammatory bowel disease nurses (ibd-n) across england: correlation with metrics of unplanned hospital care for adult services

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Abstract

Introduction

Despite better IBD-N provision in the UK, national audit suggests only 48% of patients admitted as an emergency are seen by a specialist nurse.(1) An estimated 1 00 000 people with IBD don’t have access to an IBD-N and 63% of services don’t have enough IBD-N to meet the needs of everyone affected.(2) Duties in elective services may compete with the availability of an IBD-N to support hospitalised patients. Although data is available for basic levels of IBD-N provision, there is no published information relating current levels of staffing to emergency care workload.

Method

Data sources: (a) UK IBD Audit: Hospital data for IBD-N provision, expressed as Full Time Equivalents (FTE) reported in organisation audit for Dec 2013 (3); (b) Hospital Episode Statistics for England (2013/14): relating to all cases coded with an IBD-specific code, including their all-cause hospitalizations. Site mapping: Hospital sites participating in audit were mapped manually to organisational site codes available in HES, matching 140 hospitals. Data Analysis: For HES data, algorithms based on admission method, coded diagnoses and procedures were used to categorise admissions, extracting a series of metrics including annual counts and total emergency bed days (EmBedDays) for IBD-related emergency admissions, aggregated at site level.

Results

Provision tends to increase with higher burden of unplanned care at site level, but only with modest correlation between IBD-N (FTEs) and IBD-specifc EmBedDays, r=0.47 (p<0.001). This masks a high degree of site variability: Annual IBD-related EmBedDays ranged from 286–1736 for sites with Zero FTE (n=16 hospitals), 243–2295 for sites with 1 FTE (n=38) and 438–2699 for sites with 2 FTE (n=22), equating to between six and nine fold variation in unplanned bed days at a given level of nursing provision. We did not find a correlation between FTE and a simple site-level process measure (e.g. crude 30 day readmission rate; r=−0.11, p=0.21) but further metrics will be evaluated.

Conclusion

Provision of IBD-N is not matched to unplanned care workloads for English hospitals. The emergency bed days falling within the potential remit of an individual IBD-N may vary as much as nine fold between different hospital sites.

Conclusion

[Funding: Crohn’s and Colitis UK]

Disclosure of Interest

M. Shawihdi: None Declared, A Kneebone: None Declared, K Bodger Conflict with: AbbVie, Conflict with: Boston Scientific | Takeda

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