UK IBD Audit 3 rd Round

UK IBD Audit 3rd Round Comparison of (Your Site Name) results against the National Results for Clinical Audit of Paediatric IBD Inpatient Care in the UK Name of presenter

Participation in round 3: • 23 paediatric sites across the UK entered clinical audit data • England = 17 sites • Northern Ireland = 1 site • Scotland = 3 sites • Wales = 2 sites • A ‘site’ typically constitutes a single hospital within a health board/trust. Where a health board/trust has more than one hospital offering independent IBD services they entered data for separate ‘sites’. Some institutions running a coordinated IBD service across two or more hospitals with the same staff took part as one health board/trust-wide site

Publication of results • Data was entered by sites onto a password protected audit web tool under the direction of a designated site lead, in almost every case a Consultant Gastroenterologist • Data entered between 1 September 2010 and 31 August 2011 • The results provide contemporary UK-wide data and all participating sites have received site-specific reports which will included local data for comparison against national averages (use this data to populate the ‘your site’ column in all following tables) • The full National Report was launched on 21 February 2012

Key Results – Ulcerative colitis Paediatric IBD Care – Ulcerative colitis. Table (2) of National Paediatric Report UK Results v Your Site 2010 (page 7)

Key Results – Ulcerative colitisTable (2) of National Report UK Results v Your Site 2010

Key Results – Crohn’s disease Paediatric IBD Care – Crohn’s disease. Table (2) of National Paediatric Report UK Results v Your Site 2010 (page 8)

Key Results – Crohn’s diseaseTable (2) of National Report UK Results v Your Site 2010

Key Findings – Ulcerative colitis & Crohn’s disease Ulcerative Colitis & Crohn’s disease – findings relate to key results indicated in Table(2): Paediatric IBD Care. UK Results v Your Site 2010 (page 8)

Key Findings • Increase in paediatric IBD patients being seen by specialist paediatric IBD nurse • Significant increase in stool sample collection in UC patients • Prescription of Prophylactic Heparin although increased remains low • Only 20% of UC patients admitted as an emergency had a PUCAI score recorded on day 1 • More laparoscopically or laparoscopically-assisted surgery now • Readmission rates in the two years prior to admission have fallen significantly in CD patients, with a numerical but not statistically significant fall also demonstrated for UC patients • The increase in inpatients being seen by a dietician would suggest that important dietary factors in CD arecontinuing to be given further emphasis in patient care

Key Recommendations Recommendations for Paediatric IBD Care - IBD Services based on findings collated for Ulcerative Colitis & Crohn’s Disease as detailed in tables (2) of National Report (page 8)

Key Recommendations: • Implementation at a national level, of an agreed systematic annual review to avoid likelihood of routine data collection items such as smoking and pubertal status being overlooked • Local policy for thrombus prevention (including use of Heparin) in paediatric patients with IBD should be reviewed by each paediatric IBD service • Every paediatric patient admitted as an emergency with UC should have a PUCAI score recorded on admission and daily thereafter as a guide to the need for medical rescue therapy or colectomy • Local hospitals should develop a practice were testing for CDT is routinely carried out alongside tests for SSC in all stool samples sent for IBD patients admitted with diarrhoea • All paediatric CD inpatients should have growth and nutrition reviewed during their admission to ensure that any growth faltering is not overlooked

Key Indicator Data • The table in section 5 (page 31) of the report gives named data in alphabetical order of participating site (divided by health board / SHA) • These data items were agreed by the UK IBD Audit Steering Group as reflecting the questions of particular importance to IBD patients • The combined data from all 23 sites are shown for comparison • These results should be interpreted within the context of the fact that many sites entered a relatively small number of cases to the audit and therefore percentages should be reviewed alongside the actual number of cases submitted

Key Indicator Data

Summary of National Results • These results highlight: • Highly significant increase in total number of paediatric inpatients being seen by an IBD nurse during admission • Readmission rates have fallen in both UC and CD between the 2008 and 2010 • Deficiencies in the collection of stool samples for Standard Stool Cultures (SSC) identified in 2008 clinical audit report have improved significantly for patients admitted with UC and more steadily for those admitted with CD • Laparoscopic surgery is more common in 2010 than 2008 with a significant increase in non-elective CD cases being undertaken in this way • Rates of anticoagulation have improved for patients with both UC and CD • Results highlight that there is work to be done by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) to address poor levels of recording pubertal status of patients with CD; and also to encourage widespread adoption of the Paediatric Ulcerative Colitis Activity Index (PUCAI) in order to inform the management of acute UC

Action Plan

Your 3 key areas for local change:

The Future: • Data entry for the biologics audit element of the round 3 UK IBD Audit continues. An interim report will be published in June 2012 • Enter data for your IBD patients receiving biological therapy at: www.ibdbiologicsaudit.org • Sites are encouraged to access and contribute towards the Shared Document Store on the IBD Quality Improvement Project (IBDQIP) website: www.ibdqip.co.uk which provides tools that sites can use to implement change within their own IBD Service.

Acknowledgements • Most importantly thank you to all of the people who worked within ‘Your Site’ towards collating and entering the data • All members of the UK IBD Audit Steering Group • For further information contact: • ibd.audit@rcplondon.ac.uk

UK IBD Audit 3 rd Round