Specialized Emergency Department Assessment and Multidisciplinary Intervention After Discharge Improve Management of Patients With Inflammatory Bowel Diseases

Abstract

Goal:The aim was to assess proactive specialized inflammatory bowel diseases (IBD) emergency department (ED) consultation and multidisciplinary IBD team (IBD-MDT) intervention on IBD-related patient outcomes after discharge.Background: Despite advances in patient care, IBD-related ED visits have increased and substantially contribute to the IBD burden.Methods: Consecutive patients with IBD (below 50 y) who visited the ED during November 2017 to April 2018 (intervention group) were compared with patients with IBD that visited the same ED during 2014 to 2017 (standard-care group). The primary outcomes were hospitalization and ED revisits at 30, 90, and 180 days. Results:The intervention group (45 patients, mean age 32.43 ± 8.6 y, 57.8% male) and the standard-care group (237 patients) had comparable baseline characteristics, including age, sex, and IBD type, and similar rates of hospital admissions from the ED (46.7% vs. 38.8%, P = 0.32). The intervention group more frequently underwent computed tomography (40% vs. 8%, P < 0.001) and surgical interventions (13.3% vs. 0.8%, P < 0.001) within the same hospital admission, compared with the standard-care group. In the intervention group, 24 patients were discharged from the ED, of whom 17 patients visited the IBD clinic (median 5 d postdischarge) and the majority were referred to ambulatory IBD-MDT services (dietitian: 46.7%, psychologist: 6.7%, advanced endoscopist: 8.9%, and proctology services: 6.7%). The intervention group had significantly fewer ED revisits than the standard-care group (30 d: 4.4% vs. 19.8%, P = 0.013; 90 d: 4.4% vs. 35.9%, P < 0.001; 180 d: 6.7% vs. 43%, P < 0.001). Conclusion:Proactive specialized ED assessments and IBD-MDT interventions after a hospital discharge were preferable; they significantly reduced the ED revisit rate for at least 6 months.

A Real-World Prospective Cohort Study of Patients With Newly Diagnosed Crohn’s Disease Treated by a Multidisciplinary Team: 1-Year Outcomes

“…It is also not unlikely that the close contact of these patients with our ancillary team members who provided guidance, education, and accessibility impacted response and remission rates. We and others have already shown that an MDT approach and improved accessibility to medical consults benefit decision-making, patients’ quality of care, and rates of hospitalizations 27–30 ; however, our current results suggest that the MDT approach possibly improves disease outcomes.…”

Clinical approach to skin eruptions induced by anti-TNF agents among patients with inflammatory bowel diseases: insights from a multidisciplinary IBD-DERMA clinic

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Editorial: Interdisciplinary and multidisciplinary approach to malnutrition in patients with inflammatory bowel disease

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“…8 For example, an IBD multidisciplinary care approach upon presentation to hospital and postdischarge reduced hospital readmissions. 9 Nutritional risk screening in both the inpatient and outpatient setting 10 is needed. An advantage of outpatient screening is that it enables earlier patient access to dietitians with IBD expertise.…”