N30 Exploring the effects of nurse-led clinics on the Inflammatory Bowel Disease service
Authors: Bartolay K , Hu E , Yogi K , Grafton R , MacFarlane K , Andrews J M , Lynch K D 
Published: January 2025

Background

The increasing incidence of inflammatory bowel disease (IBD) has led to greater demands on the healthcare system.1 Lack of access due to longer wait times for new referrals to tertiary IBD services can lead to worse health outcomes and reduced quality of life for people affected.2

We sought to determine whether introducing a nurse-led clinic (NLC), can improve clinic wait times and enable new referrals (category 1 &lt;30 days and category 2 &lt;90 days) to be reviewed within their allocated time frame.

We also explored the experience and satisfaction of people with IBD reviewed by their usual consultants compared to NLC.

Methods

Individuals were triaged to NLC based on strict inclusion and exclusion criteria: recent pathology with normal inflammatory markers (faecal calprotectin &lt;200mcg/g, C-reactive protein &lt;8mg/L), a review with consultant in the last 18 months, and have stable IBD over the previous 12 months. People with active perianal disease, significant end-organ damage, coexistent liver disease, other severe comorbidities or those transitioning from paediatric to adult services were ineligible for NLC.

Data on clinic wait times was collected over 6 months, from August 2023 to February 2024 and compared to a one-year period from August 2022 to July 2023, prior to the introduction of the NLC.

All people attending both NLC and consultant reviews were invited to complete an anonymous patient satisfaction survey where they could rate their experience on a scale of 1-10. (Table 1)

Results

Of the 65 people seen in NLC, median age 39 years (IQR 23-76); 35 (54%) were female. In this cohort, 41 (63%) had Crohn’s Disease (CD), 23 (35%) Ulcerative Colitis (UC), and 1 (2%) IBD-Unclassified (IBD-U).

During the same period, 358 people were seen in consultant clinics; median age 43.5 years (IQR 18-87); 198 (55%) male. In this cohort, 211 (59%) had CD, 126 (35%) UC, 8 (2%) IBD-U and 13 (4%) did not have IBD.

Following the introduction of NLC, 80% of urgent category 1 referrals were seen within the recommended timeframe, compared to 60% prior. For semi-urgent category 2 referrals, 95% were reviewed on time, up from 79% at baseline.

When combining both categories, the overall proportion of referrals reviewed on time increased from 71% at baseline to 89% during the NLC period, reflecting an 18% statistically significant improvement (p-value = 0.0486). (Figure 1)

Surveys were completed by 69 people (52 consultant clinic; 17 NLC). The overall mean score calculated for consultants was 9.1/10, while the overall mean score for nurses was 9.4/10. (Table 1)

Conclusion

This pilot study showed the potential value of a nurse-led clinic to improve clinic wait times in an IBD service, whilst maintaining patient satisfaction.

References

Wang R, Li Z, Liu S, Zhang D. Global, regional and national burden of inflammatory bowel disease in 204 countries and territories form 1990 to 2019: a systematic analysis based on the Global Burden of Disease Study 2019. BMJ Open, 2023; 13:e065186. doi: 10.1136/bmjopen-2022-065186.

Prentice JC, Pizer SD. Delayed access to health care and mortality. HSR. 2007; Apr;42(2):644-62. doi: 10.1111/j. 1475-6773.2006.00626.x.