IBD organisational audit - Adult report - round four 2014

Produced by:

This report examines the quality of adult IBD services throughout the UK. Participating services were asked to report the status of their own service as at 31 December 2013. The quality of a service is assessed against the Service Standards for the healthcare of people who have Inflammatory Bowel Disease. The UK IBD audit provides the widest view of current service provision for patients with IBD. Through the collection of these data, the audit seeks to improve all aspects of care for people with IBD in the UK.

Key recommendations

  1. There are demonstrable improvements in many aspects of care. However, for a number of important, patient‐focused quality indicators, progress has been slower, and there will need to be a national plan of action to ensure that IBD services continue to improve in these areas; this applies equally to adult and paediatric services.
  2. Provision of specialist IBD nurse support remains a priority. Although some progress has been made, further appointments are needed to enable services to meet the standards and to be able to offer patients access to a robust and reliable IBD nurse service.
  3. Nutritional assessment and dietetic support for IBD patients is an essential aspect of IBD care. Services must implement appropriate protocols to ensure that all IBD patients are reliably screened for nutritional risk factors on hospital admission and have access to dietetic support when required.
  4. IBD multidisciplinary team meetings have established their pivotal role in the management of complex IBD cases, but now require a formal footing to ensure that they occur regularly and with appropriate structure and resource.
  5. The apparent decline in access for relapsing patients to be seen quickly (within 7 days) is a concern and we recommend that services implement local systems to monitor waiting times for newly diagnosed and relapsing IBD patients. This will enable local action planning to address any issues identified.
  6. The fact that over 50% of services offer specialist support for young IBD patients undergoing transition from paediatric to adult services is encouraging, but work needs to be done to share examples of best practice to help roll out services to those sites yet to establish their own transition processes.
  7. The lack of progress with toilet provision for inpatients with IBD is disappointing and should be made a priority whenever inpatient facilities undergo improvement, or when new healthcare facilities are constructed.
  8. Patient education is of fundamental importance, given the nature of IBD, and needs to be an integral part of IBD care. Services should be encouraged to develop innovative approaches to deliver patient and family education.
  9. Despite a strong desire from the IBD community, the slow uptake of IBD databases is holding back innovation and flexibility in IBD care. Work needs to be done at a national level to overcome the barriers to the uptake of the IBD Registry and similar databases. Local clinical champions will also be required to develop business cases for funding and implementation.
  10. Given the specialist nature and low volumes of pouch surgery performed, it is essential that all pouch surgery outcomes are captured within the national pouch registry. The UK IBD audit must continue to work alongside the pouch registry to monitor this important area of IBD care.
  11. Provision of psychological support needs greater priority at a local level. This could be helped by sharing examples of successful business cases and local best practice by the small number of sites that have managed to establish a dedicated service.