Quality of care in adult patients with inflammatory bowel disease transferring between healthcare providers: multicentre audit

Abstract

BackgroundInflammatory bowel disease (IBD) predominantly affects young adults at critical socioeconomic periods of their lives. There are no studies examining the process of transfer of care for adult patients with IBD changing healthcare providers. Our aims were to assess the quality of referral information provided when patients with an established IBD diagnosis transfer care between heathcare providers and to assess the impact of referral quality on patient outcome.MethodsRetrospective data pertaining to IBD transfer of care referrals were collected from 16 hospitals across London over a 2-month period. Data were collected on patient demographics, source and content of referral and cross-referenced with an established transfer of care checklist. Patient outcome within the 6 months following transfer was also documented.Results154 cases were identified, over half of which transferred due to patient relocation. Details included in transfer letters were in many cases incomplete. In over 70% of cases, the letter came from primary care, including when a tertiary opinion was sought. Although referrals from primary care contained fewer patient data points, there was no association with poor patient outcomes at 6 months.ConclusionThis is the first study examining the quality of transfer of care in adult patients with IBD. We highlighted a significant and underreported issue and found that the majority of referrals were led by primary care. Though the inclusion in the referral of fewer data points was not associated with poor outcomes, we highlighted an area where gastroenterologists might take more responsibility to provide smooth and robust transfer of care.

Editorial: quality improvement project to identify factors associated with a delay in IBD diagnosis

“…Given that patient-associated delay was the largest contributor to delayed diagnosis, it is important to note that the odds for delayed In the UK, a significant burden is placed on GPs to refer known IBD patients to secondary care. 7 However, this study noted minimal delay in referral to secondary care of patients with suspected GI pathology/IBD, which may be explained by rigorous guidelines detailing criteria for appropriate referral. 8 The paper by Walker et al highlights that there are potentially important and avoidable delays in diagnosing a patient with IBD.…”

Transition Services for Paediatric Inflammatory Bowel Disease

“…Although our data confirm the presence of lead clinical nurse specialists and the use of transition tools in most centres, there is a lack of IBD‐specific preparation and an inability to standardise across the UK. A recent study detailing the impact of the hospital to hospital transfer of care in adult IBD patients highlights the potential for adverse outcomes where inadequate information or poor coordination occurs between healthcare providers (18). It is important to push towards a standardised approach, ensuring transition services are present across the UK through a regular audit, discussion and support for paediatric IBD centres.…”

Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps

“…The first UK Gastroenterology trainee network was created in 2015 in the Midlands and there are now at least 11 established networks with many successfully delivering regional and national projects, publishing in peerreviewed journals and presenting their data at national and international conferences. [1][2][3][4][5][6][7][8] TRNs offer the opportunity for trainees to work with and learn from peers at different stages of their training while also receiving support and guidance from senior investigators. 9 More importantly, TRNs allow trainees to develop their own ideas and prioritise projects they feel will impact their clinical practice, rather than contributing to an established programme delivered by a clinical or educational supervisor.…”

“…Alongside these changes, an increased adoption of digital information sharing with patients and virtual consultations can have a further positive impact on the environment. 3 Financial constraints are significant in many global healthcare settings, particularly in the wake of the COVID-19 pandemic. In fact, there are often financial incentives to undertake activity, which causes harm to the climate.…”