Gastroenterology
Central Middlesex and Ealing Hospitals. Since joining as a Consultant Gastroenterologist at St Mark’s Hospital in London, in 2007, I have seen a dramatic increase in patients – due to increased referrals to the hospital and an increase in prevalence, over the last 15 years. To manage this demand, the IBD service needed to expand its multidisciplinary team. The role of multidisciplinary teams (MDTs) is an underlying theme of the IBD standards, which state that patients should be cared for by a defined multidisciplinary team led by a named consultant adult or paediatric gastroenterologist. The specialist IBD team at St Mark’s Hospital consists of gastroenterology consultants, IBD specialist nurses, colorectal surgeon consultants, clinical fellows, IBD dietitians and pharmacists supported by psychological service, administrative and secretarial staff. The IBD unit at St Mark’s Hospital provides a
tertiary referral service that encompasses all aspects of care for one of the largest cohorts of patients with IBD in the UK. The hospital has a strong surgical background and attracts IBD patients at medical/ surgical crossroads. There has always been a surgical clinic and medical clinic running parallel but the two did not connect optimally; they were in different rooms on different sides of the corridor. In order to improve the care patients received
and to ensure options were presented to patients, a joint IBD clinic was implemented. At this clinic, patients are able to be assessed by a gastroenterologist, a surgeon and other members of the multidisciplinary team, such as dieticians and IBD specialist nurses, as required, within the same appointment. The overall aim of the clinic is to provide streamlined, consistent care.
Outcomes To understand the impact of the joint clinic, all patients who were routinely referred to the joint medical-surgical IBD clinic over a period of six months were asked to complete an anonymous questionnaire at the end of their appointment. Between September 2019 and March 2020,
a total of 44 patients, out of a possible 93, completed and returned the questionnaires giving a response rate of 48%. The majority of respondents viewed the clinic positively, with overall responses indicating that joint clinic appointments were preferred to seeing the gastroenterologist and surgeon separately.
Learnings At the heart of all service improvement is the need to look at the patients’ needs and provide ways in which patients can receive information and support from a multitude of clinicians. Our Trust has demonstrated a way in which patients can access a multidisciplinary team at the same time to ensure all their needs are met. If access to multiple clinicians is considered useful to patients in managing their condition, efforts should be made to ensure patients have the option to access a range of clinicians from different specialties on set days, to reduce the number of journeys made into hospital and to provide a joint care approach for patients.
Barriers to change One of the biggest challenges was the
Between September 2019 and March 2020, a total of 44 patients, out of a possible 93, completed and returned the questionnaires giving a response rate of 48%. The majority of respondents viewed the clinic positively, with overall responses indicating that joint clinic appointments were preferred to seeing the gastroenterologist and surgeon separately.
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administrative set up, as well as helping management understand how it would work. As these clinics were taking the time of two consultants simultaneously, as a team, we needed to clarify why this was so important. As a service, we had this data from an initial assessment that we undertook, and after the joint clinic had been running for a period of time, we audited the practice – asking both patients and clinicians how well they thought the service was running. We were then able to feed this back to management and prove that it is really working for both patients and clinicians. The audit highlighted the stream-lined approach and, most importantly, patients felt supported. Ultimately, if you want to provide a bespoke
service to better meet patients’ need, it is important to understand the patients in your service. The other key learning would be to just “get started”: build a good rapport with colleagues and from there you can start growing the service and building your business case. It is also important to audit the elements of the service from both the patient and clinician perspective, as this can be used to grow and design a successful service. St Mark’s is always striving for improvements
in the IBD service. Having been lucky enough to have had psychological support for patients as part of the service, our next project will be expanding this team. With IBD, some people have minimal active disease but a significant psychological burden. These psychological issues can have the largest impact not only on patients, but also on the service and the NHS, so it is important to identify and support these patients and optimise their treatment pathways.
The future of IBD care The biggest challenge going forward is the
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