PWE-043 Managing acute severe colitis in a district general hospital

    loading  Checking for direct PDF access through Ovid

Abstract

Introduction

Following a critical incident in the care of a patient with acute severe colitis (ASC) we audited practice against the European Crohn’s and Colitis Organisation (ECCO) standards for ASC. Performance was compared to the 2014 Inflammatory Bowel Disease (IBD) Audit. Since 2014 gastroenterology inpatient care changed to consultant of week instead of a single consultant. This improved discharge rates (top 4 in England for acute admission targets) but may have disrupted quality of care for more complex conditions like IBD.

Methods

Adult coding database searched for ‘colitis’ from 01/01/2016–31/10/2017. Admissions<48 hours excluded. Discharge letters were searched for ASC cases and notes then reviewed. Admissions with ASC were audited against the ECCO standards.

Conclusion

In 2014 our trust data showed we performed on par with National audit.

Conclusion

In 2017 we were equivalent to or outperformed the National figures for:

Conclusion

• Care on a specialist ward (98% vs 69%)

Conclusion

• Nutritional assessment (80% vs 82%)

Conclusion

• Dietician review (45% v 40%)

Conclusion

• Prescribing LMWH (100%)

Conclusion

• IBD nurse review (60% vs 66%)

Conclusion

We performed below the IBD audit for:

Conclusion

• Sigmoidoscopy in 72 hours (28% vs 99%)

Conclusion

• Prescribing Ca/vit D (65% vs 74%)

Conclusion

• Median time to surgery (9 vs 7.5 days)

Conclusion

Important standards of IBD nurse and dietician review maintained. Delay in endoscopic evaluation and therefore time to surgery indicate there has been a slipping of standards in ASC care. This may be related to less direct ward continuity.

Conclusion

Our data show a drop in performance (access to endoscopy and time to surgery). They have allowed us to critically appraise our acute IBD service thus leading to care delivery change and an education package for medical and surgical directorates. A repeat audit is planned in 24 months to demonstrate quality improvement as a result of this.

Related Topics

    loading  Loading Related Articles