Clinical and Experimental Gastroenterology (Aug 2020)
New Zealand National Audit of Outpatient Inflammatory Bowel Disease Standards of Care
Abstract
Robert Hackett,1 Richard Gearry,2,3 Christine Ho,4 Andrew McCombie,3 Megan Mackay,1 Karen Murdoch,5 Kirsten Rosser,2 Nideen Visesio,6 Stephen Inns1,3 1Department of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New Zealand; 2Department of Gastroenterology, Canterbury District Health Board, Christchurch, New Zealand; 3Department of Medicine, University of Otago, Dunedin, New Zealand; 4Department of Gastroenterology, Southern District Health Board, Dunedin, New Zealand; 5Department of Gastroenterology, Hawkes Bay District Health Board, Hastings, New Zealand; 6Department of Gastroenterology, Waitemata District Health Board, Auckland, New ZealandCorrespondence: Robert HackettDepartment of Gastroenterology, Hutt Valley District Health Board, Lower Hutt, New ZealandTel +64 4 566 6999Correspondence Email [email protected]: This study audits the delivery and standards of New Zealand (NZ) inflammatory bowel disease (IBD) care against international standards, with emphasis on the IBD nursing role.Methods: Utilising international standards in IBD care, a 3 phase national multicentre survey study was performed between 2015 and 2019. We 1) evaluated the current role and practices of IBD nurses, 2) evaluated IBD service provision and identified areas for improvement, and 3) audited key aspects of IBD patient care, directly comparing nurse-led and doctor-led outpatient clinics.Results: The median duration spent in an IBD nursing role was 21 months (range 2 to 120 months) with the majority (12/15) performing two or more nursing roles. The median IBD nurse full-time equivalent (FTE) was 0.8 (range 0.2 to 1.25). The average number of hours spent undertaking IBD nursing tasks was 22.2 – a 6.8-hour shortfall compared to rostered hours. No service had a per capita IBD multidisciplinary team (MDT) FTE which met international standards. Just under two-thirds (62.5%) of departments held a regular MDT meeting. All responding services could be contacted directly by IBD patients and respond within 48 hours of contact. During 492 doctor-led and 196 nurse-led scheduled outpatient clinic visits, nurses were significantly more likely to document weight, smoking status and organise appropriate colonoscopic surveillance than doctors.Conclusion: Multiple nursing job roles resulted in rostered hours being insufficient to complete IBD specific tasks. IBD FTE did not meet international standards. The IBD care was patient-centred, encouraging direct contact from patients with prompt response. IBD nurses in NZ provide high-quality outpatient care when measured against auditable standards. As the IBD nursing role continues to develop, following the implementation of an educational framework and education programme, an increase in numbers is required in order to achieve the recommended minimum FTE per 250 000 population.Keywords: inflammatory bowel disease, standards, specialist nursing, New Zealand
