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 Adult IBD Inpatient Care in the UK Name of presenter

Participation in round 3: • 198 adults sites across the UK entered clinical audit data • England = 161 sites • Jersey = 1 site • Northern Ireland = 10 sites • Scotland = 11 sites • Wales = 15 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 Adult IBD Care – Ulcerative Colitis. Table (3) of National Report UK Results v Your Site 2010 (page 8)

Key Results – Ulcerative colitisTable (3) of National Report UK Results v Your Site 2010

Key Findings – Ulcerative colitis Ulcerative Colitis– findings relate to key results indicated in Table(3): Adult IBD Care – Ulcerative Colitis. UK Results v Your Site 2010 (page 10)

Key Findings – Ulcerative colitis: • Mortality rate has halved over the 3 rounds • Statistically significant reduction in the number of patients who had been admitted to hospital for UC in the 2 years prior to the audited admission • Stool samples are now being sent significantly more frequently for both Standard Stool Cultures (SSC) and Clostridium Difficile Toxin (CDT), for UC patients admitted with diarrhoea • Significant reduction in the number of stool samples positive for CDT • 5. Prophylactic Heparin is being prescribed more frequently • 6. For patients failing to respond to IV steroids, the use of anti-TNF therapy has increased significantly and the use of Ciclosporin has dropped slightly • 7. Significant improvement in response rates for anti-TNF therapy across rounds with an improved but non-significant rise in the response rates for Ciclosporin • 8. Prescription of bone protection for patients discharged on steroids has increased

Key Results – Crohn’s disease Adult IBD Care – Crohn’s Disease. Table (4) of National Report UK Results v Your Site 2010 (page 9)

Key Results – Crohn’s diseaseTable (4) of National Report UK Results v Your Site 2010

Key Findings – Crohn’s disease Crohn’s Disease – findings relate to key results indicated in Table(4): Adult IBD Care – Crohn’s Disease. UK Results v Your Site 2010 (page 10)

Key Findings – Crohn’s disease: • Use of Anti-TNF therapy for patients admitted with CD has doubled over 3 rounds but use remains at a relatively low level overall • For CD there has not been the same increase as observed for UC in the rates of stool samples sent for Standard Stool cultures and Clostridium Difficile Toxin in patients admitted with diarrhoea • 13% of patients were taking 5-ASA drugs as the sole medication for their CD on admission. A further 21.2% were taking 5-ASA drugs with other medication but not in conjunction with any of Azathioprine, Mercaptopurine, Methotrexate or Anti-TNF therapy • 63.3% of patients were not taking any of Azathioprine, Mercaptopurine, Methotrexate or Anti-TNF therapy on admission • Significantly more patients were weighed during their admission • The number of patients seen by a dietician during their admission has continued to rise across rounds but remains at a low level overall • Just under a third of patients with CD admitted to hospital are smokers. This has not changed over the 3 rounds of the IBD audit

Recommendations for Adult IBD Care - IBD Services based on findings collated for Ulcerative Colitis & Crohn’s Disease as detailed in tables (3) & (4) of National Report (page 11) • Key Recommendations

Key Recommendations: • All IBD patients with diarrhoea should have stools sampled for both SSC and CDT testing • All appropriate IBD patients should be given heparin to reduce the risk of thromboembolism • Clinicians should consider the use of rescue medical therapy for patients that do not respond to IV steroids • Where IBD services have a IBD nurse specialist provision, the nurse should always be made aware of any IBD inpatient that is planned to commence Anti-TNF treatment to ensure appropriate counselling and screening is undertaken prior to the infusion • Bone protection should be prescribed to all patients who receive corticosteroids • Further long term data is needed on the safety, efficacy and appropriateness of use of Anti-TNF drugs. IBD Services are encouraged to participate in the ongoing Biologics audit element of the UK IBD audit • IBD Services are to review the maintenance strategies for CD

Key Recommendations continued: • Use of immunomodulators and biological therapies, in keeping with the 2011 BSG Guidelines for the management of inflammatory bowel disease in adults, will help to reduce long-term steroid use and the need for admission • A dietician should see all CD inpatients and a multidisciplinary nutrition support team must be available to IBD Services to offer advice on those patients who may require more complex enteral and/or parenteral nutritional support • Smoking cessation is an important factor in maintaining remission and in reducing the risk of relapse in CD. IBD Services should do more to encourage patients with CD to engage with formal smoking cessation services

The table in section 5 (page 35) 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 198 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

Key Indicator Data

Summary of National Results • These results highlight: • Clear evidence of sustained improvements in quality of care for IBD patients • Substantial continued improvement seen particularly for patients admitted with UC – mortality rates halved over 3 rounds of the audit • Readmission rates lowered • Percentage of patients seen by an IBD nurse specialist during admission doubled since first round • Collection of stool samples for SSC and CDT continued to improve – halving of positive CDT samples noted • Prescription of prophylactic Heparin continued to rise • Numerical but not statistically significant reduction in mortality for patients admitted with CD • Rate of operations undertaken laparoscopically increased significantly across rounds • Use of anti-TNF therapy for patients admitted with CD doubled since first round • 60% of patients with CD still not seen by a dietician during admission • Rates of collection of stool samples for SSC and CDT increased across rounds one and two but fallen back in this round • UK IBD Audit continues to demonstrate significant changes in the delivery of IBD care over a relatively short time period but there remains more to be done.

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