O-023 YI Impact of Dedicated Inflammatory Bowel Disease (IBD) Clinic on IBD-Related Hospitalizations at Veterans Hospital

Abstract

Background: IBD patients at our Veteran Administration (VA) hospital did not receive specialized care until 2014 with establishment of IBD clinic, consisting of gastroenterologist and dedicated nurse. Nurse role was patient education, improved access and continuity of care. Nurse was present during all clinic visits. Emphasis was placed on patient education of disease process, individualized treatment plan and therapeutic/adverse effects of different medications. Patients were seen in clinic within a month of discharge from hospital for flares or surgery. There was a particular focus on patient education regarding medication compliance, flare symptoms and management done during those visits. Patients have continuous, direct access to the IBD nurse and physician. We hypothesized that improved access/patient education would reduce the severity/frequency of flares and improved patient outcomes. To evaluate this hypothesis, we performed a review of the total number of visits/phone calls at the IBD clinic, and any changes in IBD-related hospitalizations before and after establishment of clinic. Methods: All visits/phone calls to IBD clinic were pulled from electronic medical record system (CPRS) over a year (May 2014 to April 2015). Retrospective chart review of patients was conducted at a single VA hospital over the timeframe of 1 year prior to implementation of the IBD clinic (May 2013 to April 2014) and 1 year after the IBD clinic (May 2014 to April 2015). A search of the electronic medical record was performed using ICD-9 diagnosis codes for Crohn's, UC and indeterminate. Search results manually reviewed and only IBD-related admissions included in the study. Results: The search for ICD-9 codes and hospital stays resulted in 1314 encounters for 290 patients in the year before implementation (2013-2014) and 1465 encounters for 275 patients the year after implementation (2014-2015). Manual review of these encounters to identify inpatient encounters narrowed the patient pool to 364 encounters for 45 patients in the year prior and 255 encounters for 42 patients in the year after. A total of 26 admissions for 14 patients with 205 hospital-days in the year before the IBD clinic, and 24 admissions for 19 patients with 171 hospital-days in the year after. There were 773 clinic visits to the IBD clinic with 993 encounters including procedures. In the year before the establishment of the IBD clinic, there were 26 admissions for 14 patients with 205 hospitaldays. In the year after, there were 24 admissions for 19 patients with 171 hospitaldays. The median length of IBD-related hospital stays reduced from 7 (3, 9) to 4 (3, 8.25) days (P < 0.0001). There was a trend towards a reduced length of hospital stay per patient per admission from 8.5 (4, 18.25) to 4 (1.5, 4) after the creation of the IBD clinic. Conclusions: Within a year of establishment of a dedicated IBD clinic for patient education and improved access, the length of IBD-related hospital stay at our VA hospital was significantly reduced.