Access to secondary care services for patients with established inflammatory bowel disease

Abstract

Background: Standards of care for inflammatory bowel disease (IBD) recommend the introduction of pathways for rapid assessment or direct admission of patients with Crohn's disease or ulcerative colitis to specialist gastroenterology services. In 2017, services provided at University Hospitals of Leicester consisted of traditional outpatient services, a dedicated gastroenterology ward and access to specialist advice via a telephone helpline, which was available Monday to Friday at 09:00–13:00. The trust did not have a dedicated service for rapid-access clinics or direct admission. Aim: A study was conducted to explore how patients with an established diagnosis of IBD accessed secondary care services, when having an acute exacerbation. Methods: A questionnaire was provided to patients over 12 months, just before their discharge from the gastroenterology ward to identify what took place during their admission. Findings: The study recruited 50 participants. The majority of these patients had been admitted to secondary care via emergency or urgent care (60%), with 22% admitted from medical admissions units, 14% directly to gastroenterology ward and 2% via other departments. For 58% of patients, the pathway to the gastroenterology ward involved being transferred to a total of three different wards. Most patients waited for many hours before entering the gastroenterology ward, and around a quarter waited for 2 days or more. Conclusions: It was found that 16% of patients had been admitted to hospital unnecessarily. Following patient feedback, a rapid-access hot clinic should be piloted to improve access pathways for patients with acute exacerbations of IBD.