P0330 The diagnostic pathway of paediatric Inflammatory Bowel Disease in a Scottish regional centre before, during and after the Covid Pandemic: Good access to endoscopy but MRI lagging behind
Authors: Motion J , Kishore S , Hansen R , Stewart C , Watson R , Lang S , Chalmers I 
Published: January 2025

Background

Health Services nationwide have faced challenges following the COVID-19 pandemic. The aim of this review was to review our current practices against the IBD UK Standards and how this has changed following the COVID-19 pandemic.

Methods

Patients diagnosed with Paediatric Inflammatory Bowel Disease (PIBD) within a tertiary gastroenterology centre (Royal Aberdeen Children’s Hospital, Scotland) from 1/1/18 to 31/12/23 were identified using an existing prospective IBD patient register. Patients were divided into Pre-Covid (diagnosis before 23/3/20), and Post-Covid (diagnosis from 19/7/21) epochs. Electronic patient records were reviewed to identify time from referral to gastroenterology review, and time from request to endoscopic assessment and small bowel MRI. These outcomes were compared to IBD standards statements 2.2 (that patients referred with suspected IBD should be reviewed within 4 weeks) and 1.10 (that endoscopy and MRI should be accessible within 4 weeks).

Results

123 patients were identified as having been diagnosed with IBD. 35 Pre, 66 Post and 22 Covid, summarised in Table 1.

In the pre cohort, 70.4% (19/27) patients with documented referral and tertiary outpatient review were seen within 28 days. This has fallen following the pandemic with 65.8% (25/38) patients meeting standards. There was a non-significant drop in median wait time for tertiary outpatient review from pre- (16 days (range 1-82 days)) compared to post-Covid cohorts (9 days (range 0–274 days, p=0.06).

71.4% (25/35) patients in the pre-covid cohort underwent endoscopic evaluation within 28 days. Median wait time was 15 days (Range 1-63 days). The proportion of patients meeting standards for endoscopic assessment rose to 91.9% (57/62) in the post-COVID cohort. The median wait significantly reduced to 6 days (range 1-112 days, p=0.008).

Small bowel MRI within 28 days of request was achieved in a similar proportion of both the Pre (18.2%; 6/33) and Post cohorts (18.3%; 11/60). However, median time to MRI was significantly higher in the Post cohort (111.5 days; range 4-303 days) compared to the Pre cohort (56 days; range 4-227 days, p=0.03).

Conclusion

Despite the NHS-wide impact of the COVID-19 pandemic, this service audit has shown stability or improvement in waiting times for both tertiary review and subsequent endoscopic assessment in those with suspected IBD. Access to MRI remains problematic and has considerably worsened after COVID-19, with median wait more than doubling compared to Pre-Covid, with similar failure to meet the 28 day recommendation in the majority of patients. Further data on the scale this challenge in IBD elsewhere would be welcome so we can understand and potentially modify the reasons for the delays seen here.

References

1.IBD UK. IBD Standards [Internet]. IBD UK. 2019. Available from: https://ibduk.org/ibd-standards, Accessed 11/11/24