Audit, Registry and QIP:

supporting the IBD

Standards
Ian Arnott
Clinical Director UK IBD Audit

Wednesday 18
th
June 2014
Setting Quality Standards
UK IBD Audit
UK IBD Audit Components
2006 2008 2010 2012
Organisation X X X X

Clinical X X X X

Paediatrics X X X

Primary care X
Patient experience X X

Biologics X X

Participation in 2013
154/162 Trusts/Health
Boards participated

95% participation rate

190 hospitals

4359 patients with
ulcerative colitis
Key findings - Organisation
Standard A1 The IBD Team
2006 2008 2010
Some IBD
Nurse
provision
69/116
(59.5%)
79/116
(68.1%)
90/116
(77.6%)
P=0.015
Key findings - Organisation













2008 2010
Written info on whom to
contact when relapse?
Yes = 69%
(120/174)
Yes = 80.5%
(140/174)

Expect to be seen within 7
days of a relapse?

Yes = 69%
(120/174)

Yes = 88.5%
(154/174
Can contact an IBD
Specialist by:
Phone
Drop in clinic
E-mail


85.7% (150/175)
11.4% (20/175)
40% (70/175)


94.3% (150/175)
9.8% (20/175)
56.3% (70/175)

Standard C2 Rapid access to specialist advice

p<0.014
p<0.001
P=0.008
P=0.615
P=0.002
Results Inpatient Care
Round 2 Round 3 Round 4
Mortality

1.54% 0.92% 0.75% *
Seen by IBD nurse 27.06% 42.01%

48.35% *
Heparin 72.78%

86.21% 90.07% *
Bone protection - 66.16% 74.00% *
Surgery 12.48% 12.23% 10.76% *
Results - Re-admissions

27% re-admitted within 2 years
12% re-admitted within 30 days

11% of patients were on no treatment
when admitted


Out-patient care
70% of patients with established UC were
seen in outpatients before admission
Median 35 days (IQR 9-104).
In those with active disease, who were not
admitted
Treatment was not changed in 42%

16% of patients on steroids >3/12
Steroids sparing therapies tried in 22%
Anaemia
Adults Paediatrics
Female

49% 58%
Male 47% 72%

70% not known to be anaemic prior to admission
34% due to iron deficiency
56% attributed to iron deficiency received no
treatment
Inpatient Experience
Overall experience
Change between rounds
Challenges
Clinical burden
Audit fatigue
Supporting quality improvement
Sources of bias
esp. Case selection and reporting
Ceiling of improvement
Being responsive to clinical need
The Future
HQIP funding ensured until Feb 2015
Focus on quality improvement
Regional meetings, patient report,
action plans
Biologics is only data collected
Re-tendering process represents a key time
point
Integration
Modernisation and simplification
Conclusion
Audit continues to drive quality
improvement
Much remains to be done
Opportunities to collaborate/come
together
HQIP funding
Key role for registry
Barriers to overcome
Benefits for all
Acknowledgements
CEEu
Aimee Protheroe
Susan Murray
Kajal Mortier
Hannah Evans
Kevin Stewart
Rhona Buckingham
Jane Ingram

CCUK
David Barker
Elaine Steven
BSG
John Williams
Jon Rhodes
Ian Forgacs
NHSE
Mike Glynn
Contact: Ibd.audit@rcplondon.ac.uk

020 3075 1566/1565

www.rcplondon.ac.uk