Introduction Inflammatory Bowel Disease (IBD) follows an unpredictable clinical course, adversely affecting quality of life for many patients. Access to specialist IBD services is necessary in addition to routine review in the outpatient setting, when patients are often stable. Accessing these services is a considerable source of frustration amongst IBD patients. Due to the complex nature of IBD management GPs now play a relatively minor role, however often become the first point of contact. It is widely acknowledged that patients value access to specialist services. IBD specialist nurses are invaluable in providing continuity of care and bridging the gap to multidisciplinary secondary care services. By providing an open access, non-face to face nurse led IBD service, we are able to use our dataset to inform and commission service transformation and improve patient outcomes.
Methods Data was extracted from a comprehensive dataset of unrestricted non-face to face interactions. This was taken from consecutive patients over a 12 month period for immunosuppression monitoring and a consecutive 3 month sample for all other data.
Results The total number of consecutive contacts with the service in 12 months in the year 2015 was 4358, rising from 3000 contacts in 2014. Monitoring of immunosuppressive treatment constituted the greatest workload with 1500 contacts in 12 months from 450 patients. In a 3 month period, provision of our service avoided 20 hospital admissions, 34 accident and emergency department attendances and 110 outpatient appointments. We supported patients by issuing 120 prescriptions, organising 24 procedures, 22 multidisciplinary discussions and 12 urgent surgical reviews. This was achieved via 1600 emails, 1400 telephone calls and 1000 contacts from 400 patients using the ‘Patient Knows Best’ software, in a 12 month period.
Conclusion Our dataset has enabled analysis of the workflow of an open access non-face to face service. The volume of workload demonstrates that patients highly value this form of support. The flexibility of the service has diverted pressure of immunosuppressive monitoring away from busy consultant clinics. This data has helped to inform service transformation by allowing costing on new local tariffs for non-face to face appointments. Contacts are currently tariffed at £25, regardless of time invested, value added or outcome. In the past, this has been a disincentive to seeing IBD follow ups in comparison to the tariffs attracted for new patient workflow. We estimate the tariff for each contact with the non-face to face service to be £60.
Disclosure of Interest None Declared
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