Background In the IBD centre, Mercy University Hospital( MUH), all patients (Approximately 4000 patients with IBD) attend the outpatient clinic for face-to-face consultations as per prescheduled appointments regardless of disease status. Mismatch between need and access to care. Patients in remission attend for elective appointments, while patients in need of urgent specialist review may have to wait or else attend clinics which are already at capacity as an urgent appointment. The increasing strain on the OPD system calls for new models of care to be explored. Aim :develop and implement a pre-clinic screening , triage system and virtual consultations for low-risk patients & evaluate the impact on patient reported and health service outcomes. Prioritise patients with more unstable IBD symptoms for face-to-face consultations, while for patient with stable IBD to increase consultation choice (virtual or face to face) …Examine impact on patient experience …Examine impact on OPD waiting lists Methods QIP conducted over a 6 month period. 1980 patients included in the study. 1560 patients were scheduled to attend OPD in the 6month timeframe and 420 patients were on the IBD OPD waitlist for return/ first time consult. logic model planning and PDSA cycles to develop ,test, refine and implement; 1.A pre-clinic screening, assessment and triage pack to assess patients clinical status and education needs 2.Inclusion and exclusion criteria for virtual consultations 3.Clinic pathway algorithms 4.Weekly virtual IBD MDTs Results 95% of patients completed the pre-clinic screening and triage pack, of these 37% were eligible for telephone consultation and 89% of those deemed eligible were happy to switch from face to face to telephone consultation. 30% of patients who attended for pre-clinic screening and triage assessment required fast tracking of OPD appointments due to unstable disease and received earlier interventions e.g. colonoscopies, MRI’s and medication optimisation. IBD waiting list of 420 patients was cleared with this initiative, all patients were offered a telephone or OPD consultation based on the result of the pre-clinic triage assessment and patient preference. 83% of patients would be happy to continue with the new model as it was perceived as more convenient , time efficient and less disruptive to everyday life. Conclusion This study highlighted that virtual management of IBD is acceptable to patients, significantly decreased clinic visit utilisation and can reduce the growing burden of IBD on health care resources .This initiative had many positive organisational outcomes including the elimination of the IBD OPD waiting list, reduction in non-essential clinic attendances and potential cost savings.

Background The Inflammatory Bowel Disease Centre in the Mercy University Hospital ( MUH) has a patient population of approximately 4000 patients with IBD, of these roughly half are women and many are diagnosed during their reproductive years. • Caring for this patient cohort can be a challenge due to patient lack of knowledge surrounding IBD and pregnancy misinformation that can occur. The aim of this project was to identify the unmet education needs of patients in relation to pregnancy and IBD. Subsequent aims were to improve patient care through the establishment of IBD preconception and pregnancy education clinics Methods An audit was carried out at the IBD infusion suite and Nurse led clinics over a 20-week period between April- August 2021. 448 patients between the ages of 18-45 were identified during this timeframe and asked to complete and IBD and pregnancy questionnaire. • The questions to assess education needs were Q1) Are you planning pregnancy in the next 2years? Q2 Has your diagnosis of IBD affected your family planning in any way? Q3) Do you feel well informed/prepared from an IBD perspective to start/continue your family? Q4) Do you have any questions or concerns regarding IBD and pregnancy e.g. Disease flare up impact on pregnancy, mediation queries/concerns, impact of pregnancy disease process Q5) What do you feel the percentage risk of your baby developing IBD would be ( 0-10%, 10-20%,20-40% or >40%) Q6 Would you be interested in attending a pregnancy education clinic led by and Advanced Nurse Practitioner? Results 55% of respondents were women. • 89% of respondents felt they needed more education on IBD and pregnancy. • 70% of respondents were concerned about the impact of an IBD flare up on fetal health with 19% remaining voluntarily childless. • 95% of patients had questions/concerns about the effects of biologic drugs on pregnancy outcomes. • 90% of patients said they would attend IBD ANP led preconception and pregnancy education clinics. • 84% of patients overestimated the percentage risk of their offspring developing IBD, with 59% estimating the risk to be greater than 20% Conclusion This audit identified the need for preconception and pregnancy education clinics for patients with IBD to improve patient education, care and outcomes. ANP led preconception and pregnancy education clinics have been established since October 2021 & are ongoing. Currently between 8-12 patients attend exclusively for preconception counselling per month. Referrals are received from Consultants within the IBD Centre MUH