The IBD Service - a concept

Dr Keith Leiper, The Royal Liverpool and Broadgreen University Hospitals

Consultant Gastroenterologist

Many hospitals have long had an IBD service which delivers high quality and timely care. These usually developed through collaboration between interested gastroenterologists and surgeons. Other hospitals have never had an identifiable or co-ordinated IBD service. It may surprise many to know that 26% of hospitals have no timetabled meetings between gastroenterologists and surgeons.

The UK IBD audit [1] has shown that there is a) marked variation in resources for IBD between hospitals and b) an unacceptable variation in the quality of care for IBD. It is very likely these two are linked. For example 44% of hospitals in the UK have no IBD specialist nurse. Presence of a specialist nurse correlates with higher standards of care (e.g. prophylactic heparinisation, bone protection, stool cultures) and improved access for patients to IBD services. There are also major differences across the UK on the access to and availability of ileo-anal pouch surgery and laparoscopic surgery for IBD. Only 10% of 927 resections for Crohn’s disease were performed laparoscopically with a range of 1.5% to 24% between regions. Nationally some crucial aspects of care are performed poorly, such as timing of surgery for acute severe colitis, excluding C.Diff associated diarrhoea, reporting of histology, appropriate and safe use of steroids.

The IBD Service Standards Working Group has been working on key standards that define an IBD Service. The aim of this group is to improve the care of patients with IBD across the UK. Key to the concept of an IBD Service is an IBD MDT. We have struggled to invent a term that avoids the sense of ennui that the letters MDT induce. The idea is that this is an entirely rewarding and educational clinical experience! Not all IBD patients would be discussed but only those who would clearly benefit from MDT discussion- for instance those with complex perianal disease, on continuous corticosteroids for more than 3 months, or initiation of biological therapy. Clearly an IBD service needs adequate resource to provide high quality care. A consultation document will be circulated soon to all members of the BSG and ACP defining the minimal resource an IBD service requires. However we also need to define an output for commissioners to measure the investment of resources. Key to this is a measurable set of standards of care for IBD which can be regularly audited.

In this presentation I will present some of the deficiencies in resources and quality of care revealed by the National IBD Audit. I will discuss the concept of an integrated IBD service, which personnel are required and what an IBD Service should provide and ideas for a longer term national strategy for IBD throughout the UK.

[1] Leiper K et al. UK Inflammatory Bowel Disease Audit 2006. http://www.rcplondon.ac.uk/college/ceeu/ceeu_uk_ibd_audit_2006.pdf,
The Royal Liverpool and Broadgreen University Hospitals