Hospitalized patients with ulcerative colitis (UC) require specialty care from a multidisciplinary team resulting in the potential for care gaps. Recent data suggests that implementation of an UC care pathway can improve some aspects of care such as short term remission and facilitation of early surgery. Our Inflammatory Bowel Disease Program developed an inpatient UC cohort following implementation of an acute, severe UC pathway. Here we present the control data for the cohort to identify care gaps we hypothesize will improve with the UC pathway.Methods:
We conducted a retrospective cohort study by querying one academic institution and 2 community hospitals in Minneapolis, Minnesota to evaluate UC admissions over 5 years (between 2009 and 2014). We included patients with confirmed ulcerative colitis presenting with ulcerative colitis flare based on ICD-9 codes 556.x. Manual chart review was performed to ensure the primary reason for admission was UC flare.Results:
Over the 5-year retrospective course of the study, 90 patients were admitted with acute, severe ulcerative colitis. The majority of these patients were female (56.7%, 51/90) and white (79/90, 87.8%). Most patients were admitted through the emergency department (61/90, 67.8%). Computed tomography (CT) was performed in 44.4% of patients. On admit, only 7.8% of patients (7/90) admitted with ulcerative colitis were receiving rectal therapy. The majority of patients were made NPO on admission (52/90, 57.8%). Venous thromboembolism (VTE) prophylaxis was ordered in 26.7% of patients (24/90), but only adequate prophylaxis was ordered in 15.6% of patients (14/90). While 66.7% had endoscopy performed, none reported an endoscopic Mayo score to quantify the activity of disease. Seventy-six percent (68/90) of patients were hospitalized for more than 3 days with a median length of stay of 5.7 days. On discharge, 29% (26/90) had evidence of ongoing rectal bleeding documented in the chart. Prior to discharge only 22.2% (20/90) of patients had GI follow-up appointment scheduled while 45.6% of patients had a documented GI follow-up post-discharge (mean time-to-appointment of 36.3 d). Readmissions were high, with 25.6% of patients returning to the hospital by 30 days and 42.2% of patients returning to the hospital by 90 days post-discharge.Conclusions:
While guidelines exist for hospitalized UC patients, adherence to these recommendations is poor. Certain components of care are likely over utilized, such as CT scans and NPO diet orders, while other aspects, such as rectal therapy, VTE prophylaxis and prompt GI follow-up are lacking. We hypothesize that implementation of an inpatient UC pathway will improve these components of care and have a measurable impact on readmission rate.