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Emergency admissions fall as service change designed to improve patient outcomes takes effect

A report evaluating the impact of changes made to the inflammatory bowel disease service (IBD) at Cardiff and Vale University Health Board (CAVUHB) shows patients’ outcomes and experiences have improved.

The report was commissioned by the Welsh Value in Health Centre (WViHC) and undertaken by CEDAR (Centre for Healthcare Evaluation, Device Assessment and Research).

It outlines an observed reduction in the number of people with IBD needing to attend the emergency department and needing surgery to manage their condition, after the service changes were introduced.  Patient feedback was also very positive, reflecting the person-centred approach to care developed by the clinical team.

Comparing the figures for 2010 to 2016 (before the service changes began) to 2022, the data shows 39% fewer IBD patients went to ED and surgery was down by 30%.

The evaluation concludes the patients it surveyed have a high satisfaction rate with the service, as in how it is meeting their desired outcomes.

One of the high costs in IBD comes from the use of biologics drugs as a treatment.  In 2017, the IBD team in CAVUHB worked with global biopharmaceutical company Takeda to secure reduced-priced biologics.

The reduced purchase price was used to support the service changes, using a value-based approach, with the aim of improving patient outcomes and experience.

The changes they made were brought in over a period of time and spanned across the COVID pandemic.  They were not overnight changes, which is why the comparable data is over six years.

Some of the service change initiatives were patient-initiated follow up appointments, dedicated infusion rooms (to administer the biologics), an IBD telephone helpline exclusively for IBD patients, patient self-management and hot clinics.

All these measures are designed to reduce the number and severity of an IBD flare, to improve the management of the condition in the community, thereby preventing the need for hospital admissions and invasive surgeries.

The hot clinics are an excellent example of that.  If a patient presented themselves at the hot clinic with an IBD flare up (which can be a common occurrence with the condition), it meant they could be reviewed the same day by someone with specialist expertise.  They could have blood tests for example or abdominal X-rays, and receive all the appropriate investigations into their flare there and then. 

The IBD team say before the hot clinic, it is likely patients would have been admitted to hospital to have investigations on a ward.  This could lead to a one or two day stay.  The hot clinic means patients can be seen within a few hours, leave with their results and importantly with strategies put in place to help deal with future flares.

In conclusion, the evaluation report is clear that patients are positive about their experience of the IBD service and that there is an observed reduction in the number of people with IBD needing to attend ED or needing surgery, following the service changes.  However, what the report does recommend is a further analysis around cost benefit and more investigation into the outcome data to understand more about the impact of the hot clinic and the telephone helpline. 

This report shows a service adopting one of the Welsh Value in Health Centre’s main principles, to deliver the outcomes that matter to people with the resources we have. 

You can read the report in full here: