P1074 Deep dive into an IBD service: mapping and identifying service gaps
Authors: Kemp K , Cornick S , Howard W , Oven D , Puleston J , Gordon D 
Published: January 2025

Background

Similar to numerous IBD services, our institution experienced an increase in patient demand without a corresponding growth in capacity to meet this. The decision to implement a turnaround strategy for the IBD service was made by members of the MDT IBD team. A Transformation Director was commissioned to collaborate with the IBD team to identify service gaps. This project commenced in December 2023 and was concluded in March 2024. The aim was to undertake a deep dive into the IBD service, provide evidence for investment and to create a well-managed, preventative service that prioritises patient safety.

Methods

We developed a workforce model based around IBD and service and the interventions required to support different levels of IBD severity. The project consisted of four stages: cohort sizing, detailing the service; identifying service requirements and workforce gap analysis. Using EPIC© electronic patient records system we were able to identify and cohort the population, define disease severity in 10,500 patients. We were able to annualise the clinical case load, measure this against current provision and using evidence from national and international standards of care, clearly identify the required workforce and gap.

Results

A workforce gap of 6.7 WTE nurses was identified utilising Leary et al (2018) workforce modelling. Additional deficiencies included pharmacy time, consultant gastroenterologists and colorectal surgeons and lack of psychology provision. Through the application of faecal calportectin we were able to map the disease severity of the patient cohort. There is significant interest from health practitioners and policymakers in interventions to reduce the burden of inappropriate A&E attendances. We were able to retrospectively determine the number of A&E attendances over a 19 month period with associated inpatient stays and identify peaks in attendances and admissions correlating with staff departures and illness in the team (see Figure 1)

Conclusion

By identifying the gaps in service we have been able to engage with hospital executives with an acknowledgement of under investment in IBD services and a coordinated plan of recovery and implementation of several initiatives including an IBD Hot Clinic, additional IBD Advanced nurses and Consultant Gastroenterologist and colorectal surgeons and the introduction of psychological services. The implementation of the deep dive is expected to yield multiple benefits and provide preventative safe and high-quality care. The results have served as evidence for immediate and future investment in the IBD service. The model developed can be used across other long-term conditions and other IBD services.

References

Alison Leary, Isobel Mason, Geoffrey Punshon, ‘Modelling the Inflammatory Bowel Disease Specialist Nurse Workforce Standards by Determination of Optimum Caseloads in the UK’ Journal of Crohn’s and Colitis, Volume 12, Issue 11, November 2018, Pages 1295–1301, https://doi.org/10.1093/ecco-jcc/jjy106

Figure 1: Hospital admissions (NEL non elective admissions)