<p>New Zealand National Audit of Outpatient Inflammatory Bowel Disease Standards of Care</p>

Abstract

This study audits the delivery and standards of New Zealand (NZ) inflammatory bowel disease (IBD) care against international standards, with emphasis on the IBD nursing role. Methods: Utilising international standards in IBD care, a 3 phase national multicentre survey study was performed between 2015 and 2019. We 1) evaluated the current role and practices of IBD nurses, 2) evaluated IBD service provision and identified areas for improvement, and 3) audited key aspects of IBD patient care, directly comparing nurse-led and doctor-led outpatient clinics. Results: The median duration spent in an IBD nursing role was 21 months (range 2 to 120 months) with the majority (12/15) performing two or more nursing roles. The median IBD nurse full-time equivalent (FTE) was 0.8 (range 0.2 to 1.25). The average number of hours spent undertaking IBD nursing tasks was 22.2-a 6.8-hour shortfall compared to rostered hours. No service had a per capita IBD multidisciplinary team (MDT) FTE which met international standards. Just under two-thirds (62.5%) of departments held a regular MDT meeting. All responding services could be contacted directly by IBD patients and respond within 48 hours of contact. During 492 doctor-led and 196 nurse-led scheduled outpatient clinic visits, nurses were significantly more likely to document weight, smoking status and organise appropriate colonoscopic surveillance than doctors. Conclusion: Multiple nursing job roles resulted in rostered hours being insufficient to complete IBD specific tasks. IBD FTE did not meet international standards. The IBD care was patient-centred, encouraging direct contact from patients with prompt response. IBD nurses in NZ provide high-quality outpatient care when measured against auditable standards. As the IBD nursing role continues to develop, following the implementation of an educational framework and education programme, an increase in numbers is required in order to achieve the recommended minimum FTE per 250 000 population.

Inflammatory bowel disease integral care units: Evaluation of a nationwide quality certification programme. The GETECCU experience

“…The programme consisted of three phases, the third being an audit of key aspects of IBD care. However, the audit, which was performed in 14 centres in contrast to ours, was more focused on validating the role of nursing than evaluating the global aspects of an IBD unit 19 . Another nationwide study was performed in Australia.…”

“…However, the audit, which was performed in 14 centres in contrast to ours, was more focused on validating the role of nursing than evaluating the global aspects of an IBD unit. 19 Another nationwide study was performed in Australia. It consisted of a two‐phase programme, a cross‐sectional survey completed by the physicians, and a clinical audit assessing organisational resources, clinical processes, and outcome measures.…”

Inflammatory bowel disease patient‐reported quality assessment should drive service improvement: a national survey of UK IBD units and patients

“…These data hugely expand the existing, limited international literature identifying areas of most importance to patients in the delivery of high-quality care, thereby providing a framework for Q I. The importance of quality standards for IBD care has been formally recognised by the publication of many country-specific IBD standards, [5][6][7][8][9] while the European Crohn's and Colitis Organisation has clearly defined quality standards across countries and different health systems. 21 Some have used quality standards to provide accreditation for IBD units.…”

“…Standards for the provision of IBD care have also been developed in many countries, including Australia, 5 Canada, 6 New Zealand, 7 Spain 8 and USA 9 highlighting the importance placed internationally on defining the quality of care patients living with IBD should expect.…”

IBD barriers across the continents: a continent-specific analysis – Australasia

“…New Zealand published its’ first national audit of IBD care in 2020. 24 There were three parts to this audit with participation rates 75% for part 1 (IBD nursing survey), 73% for part 2 (IBD service survey) and 67% for part 3 (auditing of individual District Health Board). Similar to Australia, there were multiple staffing issues found.…”