Inflammatory Bowel Disease Audit 2010
In May 2011 the first results from the 2010 IBD Audit were published. In two separate
reports the Audit covers adult and paediatric services for Inflammatory Bowel Disease (IBD)
at over 200 hospitals across the UK and gives a picture of how close hospitals are to
meeting the national
Standards for IBD Care. Comparison with the
2006 and 2008 Audits show that there is steady improvement in services, but there is still a
long way to go (p 18 Adult Services Report). For the first time selected information about adult IBD Services at individual hospitals is
made available. Twelve data items have been chosen from the IBD Standards to illustrate how
close individual hospitals are to meeting key aspects of the national standards. The information shows, for example, whether the hospital has a dedicated Gastroenterology
Ward and the number of beds per toilet, whether there is access to an IBD Nurse Specialist
or dietitian, whether they offer a clinic where doctors and surgeons are available at the
same time when needed, whether the hospital has a policy to support transition of young
patients from the paediatric IBD team to the adult IBD Service.
  Most hospitals are meeting some but not all of the Standards for service organisation. The
individual hospital data should be interpreted with care. The fact that a hospital is not
meeting all the IBD Standards for service organisation and staffing does not automatically
mean that the hospital is ‘failing’ to provide good clinical care for their IBD patients.
However, Crohn’s and Colitis UK believes that a hospital that does fulfil the IBD Standards
is one which is more likely to provide consistently high quality specialist care and a good
patient experience. The reports can be accessed from the Royal College of Physicians website.
Report on Adult IBD Services
(The information about Adult IBD Services at individual hospitals is in pages 44 – 65 of this
report)
Report on Paediatric IBD Services
More background to the IBD Audit
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This UK-wide audit of healthcare provided by hospitals for IBD
patients has been undertaken by the
Royal College of Physicians on behalf of the professional societies for
gastroenterologists (BSG),
paediatric gastroenterologists (BSPGHAN),
colorectal surgeons (ACPGBI)
and Crohn’s and Colitis UK. The IBD Audit was developed with the help of a grant
from the
Health
Foundation and the first two rounds of audit took place in 2006 and 2008.
The third IBD Audit in 2010 has been funded by the
Departments of Health in England, Scotland and Wales as part of the national
programme of NHS healthcare audits that are intended to monitor and improve the
quality of services and care across the UK. Although there is no funding from the
Northern Ireland Health Department, the hospitals in Northern Ireland have been
included in the Audit.
The 2010 Audit is in three parts:
a) The Structure and Organisation of IBD
Services (reported May 2011).
b) The clinical care of up to 40
inpatients at each hospital, including patient and GP feedback questionnaires
(reporting in 2012).
c) The care of IBD patients who have
started treatment on biological therapies in 2011/12. These include infliximab and
adalimumab, also know as Remicade and Humira. (reporting in 2012)
The full reports are available from the Royal College of
Physicians Website and give the overall data for the UK together with a commentary
and recommendations. Each hospital receives an individual report with their data
benchmarked against the national results and a copy is provided to the Chief
Executive of their Health Trust or Board. |
Projects to improve health services for IBD patients
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The IBD Audit is one of the projects developed by the health
professional societies and Crohn’s and Colitis UK over recent years to improve
healthcare for IBD patients. These include:
The
IBD Standards which were launched in 2009 and set out the expectations for the
quality of services and care to be provided for patients
The
IBD Audit which monitors hospitals against the IBD Standards and asks them to
report on the quality of care for up to 40 randomly-selected inpatients.
The
IBD Quality Improvement Project which is developing an online self-assessment
tool and library of good-practice to help IBD Teams improve their service.
The IBD Register which is developing a national database of IBD patients to improve
service planning, facilitate benchmarking of standards of care between different
hospital trusts and enable research into which IBD treatments work better for
patients. |
Information accessible to the Public
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The full reports are available from the Royal College of
Physicians Website and give the overall data for the UK together with a commentary
and recommendations. Each hospital receives an individual report with their data
benchmarked against the national results and a copy is provided to the Chief
Executive of their Health Trust or Board.
For the first time the Adult Services Report lists a selection of
key data for all the individual hospitals who took part in the Audit. This is
included as Section 6 (page 44) in the Adult Report. |
Understanding the IBD Standards and data on individual hospital services
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The key data is based on the recommendations of the
IBD
Standards and gives a picture of the level of provision of key staff in an IBD
Team and of how the IBD Service is organised. It should be emphasised that the IBD
Standards have the status of professionally recommended practice but are not
mandatory. It should also be noted that the IBD Standards recognise that smaller
hospitals may fulfil the Standards through a formal clinical network arrangement
with other hospitals.
The key data falls into several groups:
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Recommended Standard |
Staffing
(per 1,000 patients) |
IBD Nurse Specialist |
1.5 WTE |
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Dietitian |
0.5 WTE |
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Multidisciplinary Nutrition Team |
Yes |
Facilities |
Dedicated Gastroenterology Ward or Beds |
Yes |
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Toilets |
3 beds per toilet |
Organisation |
Named clinical Lead |
Yes |
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Regular timetabled IBD Team meetings to discuss
patients |
Yes |
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Parallel or joint gastroenterology/colorectal
surgery clinics |
Yes |
Policies |
Guidelines for management of Acute Severe Colitis |
Yes |
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Shared care agreement with primary Care |
Yes |
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Paediatric to Adult care Transition Policy |
Yes |
Out-patient care |
Written information for patients on who to contact
in the event of a relapse |
Yes |
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Written care plan provided to patients |
Yes |
Rapid access to specialist care |
Can relapsing patients be expect to have a
specialist review within 7 days. |
Within 7 days |
Where hospitals do not meet the IBD Standards this does not
automatically mean that their clinical care for patients is sub-standard or that
their IBD Service is 'failing'.
The data should be seen as an indicator that the IBD staff team is
not resourced by the Trust or Board to the recommended levels or that the way the
IBD Service is currently organised could probably be improved to meet patients’
needs more effectively.
The provision of this information will allow IBD patients who
particularly value certain aspects of a high quality IBD service (for example
availability of an IBD Nurse or Dietitian) to make a choice between hospitals where
this is practical or to ask about plans for improving their local service. |
How can patients or family members help to improve their IBD Service?
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The information provided makes it possible for any patient to give
greater support to their local clinical team in improving their IBD Service to meet
the IBD Standards.
Writing to your Health Trust or Board
As an IBD patient or family member you can write to your local Health Trust or
Board and explain how improvements to your local IBD Service would make a difference
to your quality of life or experience as a patient. Or you might write and express
satisfaction that your hospital meets most of the IBD Standards and express the hope
that they should continue to have the resources to do so. This is particularly
important in relation to key members of staff such as the IBD Specialist Nurse where
there is financial pressure to cut their IBD time. We suggest that you should always
send a copy of such letters to your consultant so they are aware of your support.
Writing to your MP (England), MSP (Scotland), AM (Wales) or MLA
(Northern Ireland)
It is always helpful to raise the awareness of Crohn’s or Colitis with
politicians and let them know how your hospital is doing in relation to the IBD
Standards, whether you wish to praise the services or raise concerns, or both!
Tell your GP about your experiences of hospital care
GPs are becoming increasingly important in England in determining the funding
and planning of services. Let them know about your experiences good or bad.
Patient Involvement at your hospital
Every hospital has arrangements for involving patients in various ways – through
feedback questionnaires, local meetings, patient representatives on governing
bodies. The hospital PALS service can advise you on how you can express your views.
IBD Patient Panels
Crohn’s and Colitis UK is supporting the development of IBD Patient Panels at
hospitals to provide a means for patients actively to work with and support the IBD
Team in improving services. For more information
click here; for a list
of existing Panels
click here. If your hospital does not have an IBD Patient Panel and you would
like to help start one, please talk to your IBD consultant or specialist nurse. |
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