Report of the results for the national clinical audit of adult inflammatory bowel disease inpatient care in the UK

Transcription

1 Report of the results for the national clinical audit of adult inflammatory bowel disease inpatient care in the UK Round 3 February 12 National Report Prepared by the UK IBD Audit Steering Group on behalf of: UK IBD audit 3rd Round (10) - National Results for the Processes of Paediatric IBD Care in the UK 1

2 Table of Contents Report authors and acknowledgements... 4 Dedication... 4 Report prepared on behalf of the UK IBD Audit Steering Group by... 4 Acknowledgements... 5 Section 1: Executive summary... 6 Background... 6 Overall summary... 6 Key results... 7 Table 1: Key results for adult IBD care ulcerative colitis across all rounds... 7 Table 2: Key results for adult IBD care Crohn s disease across all rounds... 8 Key 10 UK results with Your Site comparison Table 3: Key results for adult IBD care ulcerative colitis. UK results v Your Site Table 4: Key results for adult IBD care Crohn s disease. UK results v Your Site Key findings key findings Crohn s disease key findings Key recommendations Section 2: Background information The burden of inflammatory bowel disease UK IBD audit aims Explanation of the Your Site terminology appearing in this national report Availability of audit results in the public domain Section 3: Further highlighted results National comparisons Table 5: key indicator results for England, Northern Ireland, Scotland and Wales in Table 6: Crohn s disease key indicator results for England, Northern Ireland, Scotland and Wales in Royal College of Physicians 11 2

3 IBD clinical nurse specialist involvement with IBD inpatients Table 7 IBD nurse specialist involvement in inpatient care Invitation to join a writing group to conduct further analysis on the audit data Audit methodology... Datasets and standards used in the UK IBD audit (10) data collection process... Data collection tool... Recruitment... Data required... Inclusion and exclusion criteria... New components for the 3rd round... Note on the term site used throughout the report... Audit governance... Presentation of results in section 4... Section 4: Full 10 audit results... full UK 10 results with your site comparison... Crohn s disease full UK 10 results with your site comparison Section 5: Individual site 10 key indicator data Appendices Appendix 1: Glossary / Abbreviations Appendix 2: Members of the UK IBD Audit Steering Group Appendix 3: Audit Participants Appendix 4: Action Plan Royal College of Physicians 11 3

4 Report authors and acknowledgements Dedication We wish to dedicate this report to the memory of Dr Keith Leiper MD, FRCP who sadly passed away on 21 October 11. Dr Leiper worked to develop and deliver the inaugural 06 round of the UK IBD audit and subsequently saw his vision turned into reality with the successful development and pilot of the IBD Quality Improvement Project (IBDQIP). On behalf of the UK IBD Audit Steering Group, we wish to acknowledge the hard work, commitment, enthusiasm and humour that Keith brought to the UK IBD audit. Report prepared on behalf of the UK IBD Audit Steering Group by Dr Ian Arnott Consultant gastroenterologist, Western General Hospital Edinburgh & clinical director for the UK IBD audit Ms Rhona Buckingham Manager of the Clinical Effectiveness & Evaluation Unit, Royal College of Physicians, London Mr Calvin Down UK IBD audit project manager, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Richard Driscoll Chief executive, Crohn s and Colitis UK Ms Jane Ingham Director of Clinical Standards, Royal College of Physicians, London Ms Karen Kemp Nurse practitioner gastroenterology, Manchester Royal Infirmary Dr Keith Leiper Consultant gastroenterologist, Royal Liverpool University Hospital Miss Aimee Protheroe UK IBD audit project coordinator, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Professor Jonathan Rhodes Professor of medicine, University of Liverpool Mr Michael Roughton Medical statistician, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Dr Kevin Stewart Clinical director, Clinical Effectiveness and Evaluation Unit Mr Graeme Wilson Consultant colorectal surgeon, Western General Hospital, Edinburgh Royal College of Physicians 11 4

5 Acknowledgements Firstly the UK IBD Audit Steering Group would like to thank all hospital staff who contributed towards organising the identification, retrieval and inputting of data. This includes clinical audit, information technology and clinical coding staff in addition to the members of the multidisciplinary clinical teams working in support of IBD patients. The Royal College of Physicians of London and the UK IBD Audit Steering Group (Appendix 2) would like to thank and acknowledge all who have participated in the piloting and development of the audit. We would also like to acknowledge the input from participating NHS hospitals for their helpful suggestions and comments on ways to improve the audit following the 06 and 08 rounds of data collection. The web based data collection tool was developed by Netsolving Ltd. The UK IBD Audit Steering Group recognises that participation in the audit has involved many individuals spending time over and above an already heavy workload with no financial recompense. The members of the UK IBD Audit Steering Group represent the following bodies: Crohn s and Colitis UK Royal College of Physicians, London Royal Pharmaceutical Society of Great Britain The Association of Coloproctology of Great Britain and Ireland The British Dietetic Association The British Society of Gastroenterology The British Society of Paediatric Gastroenterology, Hepatology and Nutrition The Primary Care Society for Gastroenterology The Royal College of Nursing Crohn's and Colitis Special Interest Group The UK IBD audit 3rd round is commissioned by: Healthcare Improvement Scotland The Healthcare Quality Improvement Partnership Royal College of Physicians 11 5

6 Section 1: Executive summary Background The incidence of the inflammatory bowel diseases, ulcerative colitis and Crohn s disease continues to rise and is now estimated to affect 1 in 0 people in the United Kingdom with men and women equally affected. These incurable diseases have profound life changing effects often beginning in childhood and persisting throughout life. The total cost of IBD to the NHS was estimated at 7 million in 06, based on an average cost of 3,000 per patient per year with up to half of total costs for relapsing patients 1. The cost may now be considerably more due the rapid expansion in the use of biological drugs in recent years. The first round of the UK IBD audit in 06 demonstrated an unacceptable variation in the resource and quality of care for IBD patients in the UK. The second round demonstrated that considerable progress had been made, for example in the provision of IBD nurse specialists, but it was clear at this stage that further improvement was still required. The UK IBD audit has been widely supported by clinicians. 212 hospitals across the UK contributed data towards the 1st Round with 227 hospitals providing clinical admission data for this round. Following each round change implementation has been supported with regional meetings and a web based document repository. Although IBD was not part of the National Service Framework program, results from the first round of the audit were a catalyst for the development of the National Service Standards for the healthcare of people who have Inflammatory Bowel Disease ( The UK IBD audit has, together with the adoption of the IBD Standards, driven quality improvement in IBD care and has realised substantial improvements over a relatively short period of time. Data from the UK IBD audit has been recognised by the Care Quality Commission. Data from the UK IBD audit 2nd round was included in the 09 annual health check and data from the 3rd round will also contribute towards Quality Accounts. Overall summary Data presented in this report demonstrates clear evidence of sustained improvements in the quality of care for IBD inpatients. Having the perspective of a 3rd round illustrates an ongoing audit process driven forward, and supported by, committed IBD Services across the UK. Substantial continued improvement is seen particularly for patients admitted with ulcerative colitis (UC) with mortality halving over the 3 rounds of the audit. Readmission rates have lowered and the percentage of patients being seen by an IBD nurse specialist during their admission has doubled since the first round. The collection of stool samples for Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) has continued to improve with a halving of positive CDT samples noted across rounds 2 and 3. The prescription of prophylactic heparin has continued to rise. For patients admitted with Crohn s disease (CD) there is a numerical but not statistically significant reduction in mortality. The number of patients seen by an IBD nurse specialist during their admission has doubled across rounds. The prescription of prophylactic heparin and the rate of operations undertaken laparoscopically have increased significantly across rounds. Whilst the numbers are relatively small the audit shows the use of anti TNF therapy for patients admitted with CD has doubled since the first round. Although improvements have been noted across rounds, sixty percent of patients with CD were still not seen by a dietician during their admission by the time of this latest round. The rates of the collection of stool samples for SSC and CDT increased across rounds one and two but have fallen back slightly in this most recent round. Royal College of Physicians 11 6

7 In summary, the UK IBD audit continues to demonstrate significant changes in the delivery of IBD care over a relatively short time period but there remains more to be done. This is an on going process and further rounds of audit will support the continued improvement in the quality of care for IBD patients. The key action points are as follows: Health departments in England, Northern Ireland, Scotland and Wales must support future rounds of the UK IBD audit so that it can continue to drive quality improvement in IBD care All NHS Trusts/Health Boards should review their local audit results in relation to the 10 BSG Guidelines for the Management of IBD along with the related NICE guidance and take any necessary action to further improve their IBD Services Clinical teams should review the results provided in their individualised site reports in line with the key findings and recommendations Key results The key results detailed below in Tables 1 and 2 show corresponding results from the 06, 08 and 10 rounds of the UK IBD audit, wherever directly comparable. These data were compiled by comparing only the results from the 128 sites that took part in all three rounds (with the same site composition in each round). The figures shown in the tables indicate the number and percentage where the response was yes to each question. Any statistically significant change is represented by an asterix to the right of the 10 data column. Table 1: Key results for adult IBD care ulcerative colitis across all rounds Table 1: Key results for adult IBD care ulcerative colitis across all rounds Did the patient die during the Where the patient had a preadmission diagnosis of UC had they been admitted for UC in the 2 years prior to the audited Were non elective patients seen by an IBD nurse during their Were stool samples sent for Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) in non elective patients with diarrhoea (recorded in the first full day following admission)? 06 (53 comparable cases of which 1668 non elective) 08 (16 comparable cases of which 1655 non elective) 10 (48 comparable cases of which 1614 non elective) 34/53 (1.7%) 31/16 (1.5%) 16/48 (0.8%) * 829/1621 (51.1%) 750/1655 (45.3%) 421/1255 (33.6%) * 395/1667 (23.7%) 496/1653 (30.0%) 725/1614 (44.9%) * SSC 738/11 (65.9%) CDT 604/11 (53.9%) Were the stool samples positive? NOT ASKED Was prophylactic Heparin prescribed for non elective admissions? Non elective patients prescribed, but not responding to, corticosteroids during the admission who received either Ciclosporin or Anti TNF therapy? Did the patient respond to treatment with Ciclosporin or Anti TNF? Was the surgery performed on elective patients undertaken laparoscopically? SSC 857/1160 (73.9%) CDT 770/1160 (66.4%) SSC 17/857 (2.0%) CDT 32/770 (4.2%) SSC 961/19 (80.8%) * CDT 882/1173 (75.2%) * SSC 24/961 (2.5%) CDT 14/882 (1.6%) * 905/1668 (54.3%) 12/1649 (74%) 1406/1614 (87.1%) * Ciclosporin 108/412 (26.2%) Anti TNF /412 (4.9%) Ciclosporin 59/108 (54.6%) Anti TNF 8/ (40.0%) Ciclosporin 117/433 (27.0%) Anti TNF 52/433 (12.0%) Ciclosporin 61/116 (52.6%) Anti TNF 40/50 (80.4%) Ciclosporin 152/655 (23.2%) Anti TNF 110/655 (16.8%) * Ciclosporin 97/152 (63.8%) Anti TNF 94/110 (85.5%) * 28/274 (10.2%) 58/362 (16.0%) 145/332 (43.7%) * Was the surgery performed on non 11/213 (5.2%) 27/7 (13.0%) 66/5 (33.9%) * Royal College of Physicians 11 7

8 elective patients undertaken laparoscopically? If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? 534/1300 (41.1%) 749/1347 (55.6%) 971/1396 (69.6%) * Table 2: Key results for adult IBD care Crohn s disease across all rounds Table 2: Key results for adult IBD care Crohn s disease across all rounds Did the patient die during the Were non elective patients seen by an IBD nurse during their Was Anti TNF therapy given during the (only includes non elective patients indicated as not already receiving Anti TNF therapy on admission) Was prophylactic Heparin prescribed for non elective admissions? Were Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) samples sent, in non elective patients with diarrhoea (recorded in the first full day following admission)? Were non elective patients seen by a dietician during the Were non elective patients weighed during the Were non elective patients both weighed and seen by the dietician during the Was the surgery performed on elective patients undertaken laparoscopically? Was the surgery performed on nonelective patients undertaken laparoscopically? a smoker at the time of 06 (74 comparable cases of which 1669 non elective) 08 (2109 comparable cases of which 1638 non elective) 10 (00 comparable cases of which 1626 non elective) 27/74 (1.3%) 23/2109 (1.1%) 15/90 (0.8%) 302/1666 (.1%) 394/1638 (24.1%) 6/1626 (38.1%) * 58/1485 (3.9%) 77/1571 (4.9%) 1/1468 (8%) * 933/1669 (55.9%) 14/1633 (73.1%) 1400/1626 (86%) * SSC 290/523 (55.5%) CDT 224/523 (42.8%) SSC 340/516 (65.9%) CDT 307/516 (59.5%) SSC 470/774 (60.7%) * CDT 426/767 (55.5%) * 598/1669 (35.8%) 557/1638 (34.0%) 645/1626 (39.7%) * 858/1669 (51.4%) 9/1638 (56.2%) 1214/1626 (74.7%) * 465/1669 (27.9%) 461/1638 (28.1%) 583/1626 (35.9%) * 47/374 (12.6%) 122/460 (26.5%) 147/361 (40.7%) * 32/364 (8.8%) 48/3 (15%) 61/298 (.5%) * 654/74 (31.5%) 674/2109 (32.0%) 617/90 (31.0%) Royal College of Physicians 11 8

9 Key 10 UK results with Your Site comparison. Tables 3 and 4 show respectively the key combined UK results from the ulcerative colitis and Crohn s disease admissions data that were entered by the 8 adult sites that participated in the audit. The your site 10 columns show where individual sites will be able to view their local results alongside the national data in their individualised site reports. Table 3: Key results for adult IBD care ulcerative colitis. UK results v Your Site 10 Table 3: Key results for adult IBD care ulcerative colitis. UK results v Your Site UK Results (3049 admissions in total of which 2554 elective) Did the patient die during the 28/3049 (0.9%) Where the patient had a pre admission diagnosis of UC had they been admitted for UC in the 2 years prior to the audited Were non elective patients seen by an IBD nurse during their Were Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) samples requested, in non elective patients with diarrhoea (recorded in the first full day following admission)? Were the stool samples positive? 656/02 (33%) 1067/2554 (42%) SSC 1537/37 (79%) CDT 1414/37 (73%) SSC 33/1537 (2%) CDT 22/1414 (2%) Was prophylactic Heparin prescribed? 2668/3049 prescribed Ciclosporin or Anti TNF during the (non electives who did not respond to corticosteroids) Did the patient respond to treatment with Ciclosporin or Anti TNF In patients undergoing surgery, was this undertaken laparoscopically? If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? Ciclosporin 225/763 (29.5%) Anti TNF 160/763 (21%) Ciclosporin 141/225 (63%) Your Site 10 SSC CDT SSC CDT Ciclosporin Anti TNF Ciclosporin Anti TNF Anti TNF 132/160 (82.5%) Elective 5/490 (42%) Elective Non Non 98/317 (31%) Elective Elective 1443/24 (66%) Royal College of Physicians 11 9

10 Table 4: Key results for adult IBD care Crohn s disease. UK results v Your Site 10 Table 4: Key results for adult IBD care Crohn s disease. UK results v Your Site UK Results (3122 admissions in total of which 2571 elective) Did the patient die during the 21/3122 (0.7%) Your Site 10 admitted under the care of a gastroenterology specialist? Did the patient see an IBD nurse during their Was Anti TNF therapy prescribed during the (only includes non elective patients indicated as not receiving Anti TNF on admission) In patient started on Anti TNF during this admission, did they respond to the treatment? 983/2571 (38%) 905/2571 (35%) 6/2509 (7.4%) 163/6 (87.6%) Was prophylactic Heparin prescribed? 2708/3122 (87%) Were Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) samples requested, in nonelective patients with diarrhoea (recorded in the first full day following admission)? Were non elective patients seen by a dietician during the Were non elective patients weighed during the In patients undergoing surgery, was this undertaken laparoscopically? SSC 726/1309 (55%) CDT 657/1309 (50%) 980/2571 (38%) 46/2571 (72%) 326/10 (32%) Does the patient smoke? 931/3122 (30%) SSC CDT How many patients had been taking steroids (at any time) for longer than 3 months continuously prior to the Was bone protection used in patients taking steroids for more than 3 months continuously? 664/3122 (21%) 404/600 (67%) What treatment was the patient taking for Crohn s disease on 5 ASA (both alone or in combination with any another medication) 1073/3122 (34%) 5 ASA only 404/3122 (13%) 5 ASA without any of Azathioprine, Mercaptopurine, Methotrexate or Anti TNF Either Azathioprine, Mercaptopurine or Methotrexate alone Either of Azathioprine, Mercaptopurine or Methotrexate AND Anti TNF 662/3122 (21%) 315/3122 (10%) 121/3122 (4%) Royal College of Physicians 11 10

11 Key findings key findings (the key findings relate to the results indicated in tables 1 and 3 above) 1. The mortality rate has halved over the 3 rounds of audit data collection (1.7% to 0.8%) 2. There has been a statistically significant reduction (51% to 34%) in the number of patients who had been admitted to hospital for UC in the 2 years prior to the audited admission. It could be argued that this drop in readmission rates is due to more responsive outpatient services as demonstrated in the national organisational audit of adult IBD services in the UK published by the UK IBD audit Steering Group in May 11. This showed that over 90% of sites reported that they could see relapsing patients within 7 days of referral 3. Stool samples are now being sent significantly more frequently for both Standard Stool Cultures (SSC), (66% to 81%) and Clostridium Difficile Toxin (CDT), (54% to 75%) for UC patients admitted with diarrhoea recorded in the first full day following admission. 4. There has been a significant reduction in the number of stool samples positive for CDT (4.2% to 1.6%) for patients admitted with diarrhoea in 10. Samples indicated as positive for CDT were reported on within a median of 1 day of having been sent for testing 5. Prophylactic Heparin is being prescribed more frequently (54% to 87%). 2% (66/3049) of patients had a thrombotic episode during their admission in the third round 6. For patients failing to respond to intravenous steroids the use of anti TNF therapy has increased significantly (4.9% to 16.8%) and the use of Ciclosporin has dropped slightly (26% to 23%) suggesting a change in the choices made by clinicians when considering rescue therapy 7. There has been a significant improvement in the response rates for anti TNF therapy (40% to 85%) across rounds with an improved but non significant rise in the response rates for Ciclosporin (55% to 64%) 8. The prescription of bone protection for patients discharged on steroids has increased (41% to 70%) as recommended in the BSG Guidelines for the management of IBD in adults Crohn s disease key findings (the key findings relate to the results indicated in tables 2 and 4 above) 1. The use of Anti TNF therapy for patients admitted with Crohn s disease has doubled over 3 rounds but use remains at a relatively low level overall (3.9% to 8%) 2. For Crohn s disease there has not been the same increase as observed for ulcerative colitis in the rates of stool samples sent for Standard Stool Cultures and Clostridium Difficile Toxin in patients admitted with diarrhoea, in fact the rates increased between rounds 1 and 2 and fell off in each case in round % (404/3122) of patients were taking 5 ASA drugs as the sole medication for their Crohn s disease on admission in 10. A further 21.2% (662/3122) were taking 5 ASA drugs on admission with other medication but not in conjunction with any of Azathioprine, Mercaptopurine, Methotrexate or Anti TNF therapy % of patients in 10 (78/3122) were not taking any of Azathioprine, Mercaptopurine, Methotrexate or Anti TNF therapy on admission 5. Significantly more patients are being weighed during their admission (51.4% to 74.7%) 6. The number of patients seen by a dietician during their admission has continued to rise across rounds but remains at a low rate overall (35.8% to 39.7%) 7. Just under a third of patients with Crohn s disease admitted to hospital are smokers. This has not changed over the 3 rounds of the IBD audit (31.5% to 31%) Royal College of Physicians 11 11

12 Key recommendations All IBD patients with diarrhoea should have stools sampled for both Standard Stool Cultures and Clostridium Difficile Toxin testing. All appropriate IBD patients should be given heparin to reduce the risk of thromboembolism. Clinicians should consider the use of rescue medical therapy for patients that do not respond to intravenous steroids. Where IBD Services have IBD clinical nurse specialist provision, the nurse should always be made aware of any IBD inpatient that is planned to commence Anti TNF treatment to ensure appropriate counselling and screening is undertaken prior to the infusion. Bone protection should be prescribed to all patients who receive corticosteroids Further long term data is needed on the safety, efficacy and appropriateness of use of Anti TNF drugs. IBD Services are encouraged to participate in the ongoing Biologics audit element of the UK IBD audit IBD Services are strongly encouraged to review the maintenance strategies for Crohn s disease. Many patients with Crohn s disease were admitted on 5 ASA drugs and there is no evidence that 5 ASA is superior to placebo for the maintenance of medically induced remission in Crohn s disease. The use of immunomodulators and biological therapies, in keeping with the 11 BSG Guidelines for the management of inflammatory bowel disease in adults, will help to reduce long term steroid use and the need for admission Many IBD patients suffer from malnutrition. A dietician should see all Crohn s disease inpatients and a multidisciplinary nutrition support team must be available to IBD Services to offer advice on those patients who may require more complex enteral and/or parenteral nutritional support. Smoking cessation is an important factor in maintaining remission and reducing the risk of relapse in Crohn s disease. IBD Services should do more to encourage patients with Crohn s disease to engage with formal smoking cessation services Royal College of Physicians 11 12

13 Section 2: Background information The burden of inflammatory bowel disease Although absent from the National Service Framework program, the inflammatory bowel diseases, ulcerative colitis (UC) and Crohn s disease (CD), are common causes of gastrointestinal morbidity in the UK. It is estimated that up to 0.5% of European and North American populations are affected. IBD most commonly first presents in the second and third decade but much of the recent increase has been observed in childhood, notably with CD in children increasing 3 fold in 30 years. IBD is not curable, UC and CD are lifelong conditions following an unpredictable relapsing and remitting course. 25% of UC patients will require colectomy and approximately 80% of CD patients require surgery over their lifetime. The main symptoms are diarrhoea, abdominal pain and an overwhelming sense of fatigue. Associated features such as arthritis, anal disease, fistulae, abscess and skin problems can also contribute to a poor quality of life. In addition, there are wide ranging effects on growth and pubertal development, psychological health, education and employment, family life and pregnancy and fertility. Effective multidisciplinary care can attenuate relapse, prolong remission, treat complications and vastly improve quality of life. UK IBD audit aims The UK IBD audit seeks to improve the quality and safety of care for all IBD patients in hospitals throughout the UK by assessing individual patient care and the provision and organisation of IBD service resources. As with the 1st (adult only) and 2nd round reports this 3rd round UK IBD audit report enables each participating site to compare or benchmark their performance against national statistics. Following the previous rounds of the audit the UK IBD Audit Steering Group looked to develop intervention strategies to ensure that the findings were acted upon. This comprised the widespread dissemination of results to participating sites through registered site clinical leads and hospital management. The results of all national reports were publicly available via the UK IBD audit section of the Royal College of Physicians website. The UK IBD audit hosted well attended regional meetings throughout the UK to discuss the audit results following both rounds of the audit. Data from both rounds was also presented at key professional and patient meetings including those of the British Society of Gastroenterology, Association of Coloproctology of Great Britain & Ireland, British Dietetic Association, Royal College of Nursing (IBD Nurse Forum) and Crohn s and Colitis UK. A number of participating sites collaborated with members of the UK IBD Audit Steering Group to develop a model Action Plan for IBD Services that addressed the key messages from the 1st round report. The model action plan was accessible via the internet and contained freely adaptable reference documents such as care pathways, model business cases for IBD clinical nurse specialist posts and patient information leaflets that could be downloaded and edited to meet local requirements. Visits to 23 randomly selected hospitals that participated in the 1st round of the IBD audit were carried out, during which a clinical member of the IBD Audit Steering Group worked alongside the health professional team responsible for IBD care to develop an action plan for their IBD Service that would address areas for improvement identified in their 1st round site specific report. Explanation of the Your Site terminology appearing in this national report For individual participating site reports, data specific to their hospital will be indicated in tables by Your Site headings. In the case of this national report no data will appear under the Your Site headings but these have been left in situ to show the format of the individualised site reports which will be compiled for each of the participating sites. The full report is supported by the UK IBD Audit Steering Group. Royal College of Physicians 11 13

14 Further information on the work of the UK IBD audit project can be accessed via the Clinical Effectiveness & Evaluation Unit section of the Royal College of Physicians website. Availability of audit results in the public domain Full and executive summary copies of this report will be available in the public domain via the Royal College of Physicians, London external website: The national report of results will be made available to the Department of Health in England, Healthcare Improvement Scotland, NHS Wales Health & Social Care Department and the Department of Health, Social Services and Public Safety in Northern Ireland. A limited number of key data results for each of the 8 individual sites that contributed clinical audit data in this round are published in the public domain in section 5 of this report, as agreed with audit participants. These data items were agreed by the Steering Group as giving an indication of how individual sites are performing in relation to key areas of IBD care of specific interest to IBD patients. Royal College of Physicians 11 14

15 Section 3: Further highlighted results National comparisons Table 5 and Table 6 depict any national variations between the 10 results for England, Northern Ireland, Scotland and Wales for ulcerative colitis and Crohn s disease respectively. Any statistically significant change is represented by an asterix to the right of the Wales data column. Table 5: key indicator results for England, Northern Ireland, Scotland and Wales in 10 Table 5: key indicator results for England, Northern Ireland, Scotland and Wales in 10 England Northern Ireland Scotland Wales Did the patient die during the 24/2606 (0.9%) 0/130 (0%) 1/141 (0.7%) 2/165 (1.2%) Did the patient have any previous admissions during the 570/1725 (33.0%) 27/83 (32.5%) 31/96 (32.3%) 26/92 (28.3%) last 2 years? by an IBD nurse during their Were Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) samples requested, in patients with diarrhoea? Were the stool samples positive? Was prophylactic Heparin prescribed? Percentage of patients receiving rescue therapy (Ciclosporin + Anti TNF) prescribed Ciclosporin or Anti TNF during the Did the patient respond to treatment with Ciclosporin or Anti TNF What was the median (IQR) time between admission and surgery in non elective patients? In patients undergoing surgery, was this undertaken laparoscopically? If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? 944/26 (43.2%) 11/114 (9.7%) 91/121 (50.4%) 51/126 (40.5%)* SSC 1325/1640 (80.8%) CDT 1223/1612 (75.9%) SSC 32/1325 (2.4%) CDT /1223 (1.6%) SSC 66/84 (78.6%) CDT 52/83 (62.7%) SSC 0/66 (0%) CDT 0/52 (0%) SSC 71/92 (77.2%) CDT 69/91 (75.8%) SSC 0/71 (0%) CDT 0/69 (0%) SSC 73/85 (85.9%) CDT 68/85 (80.0%)* SSC 1/73 (1.4%) CDT 2/68 (2.9%) 93/26 (86.6%) 102/114 (89.5%) 101/121 (83.5%) 102/126 (81.0%) 340/659 (51.6%) /39 (48.7%) 4/26 (15.4%) 13/34 (38.2%)* Ciclosporin 7/659 (31.4%) Anti TNF 141/659 (21.4%) Ciclosporin 132/7 (63.8%) Anti TNF 1/141 (83.7%) Ciclosporin 10/39 (25.6%) Anti TNF 9/39 (23.8%) Ciclosporin 4/110 (40.0%) Anti TNF 8/9 (88.9%) Ciclosporin 0/26 (0%) Anti TNF 4/26 (15.4%) Ciclosporin NA Anti TNF 3/4 (75.0%) Ciclosporin 8/34 (23.5%)* Anti TNF 5/34 (14.7%) Ciclosporin 5/8 (62.5%) Anti TNF 3/5 (60.0%) 9 (5, 14) 10 (4, 14) 6 (3, 8) 7 (6, ) 271/685 (39.6%) 5/32 (15.6%) 7/37 (.9%) /51 (37.3%) 1267/96 (66.8%) 60/91 (65.9%) 38/100 (38.0%) 77/102 (75.5%) Royal College of Physicians 11 15

16 Table 6: Crohn s disease key indicator results for England, Northern Ireland, Scotland and Wales in 10 Table 6: Crohn s disease key indicator results for England, Northern Ireland, Scotland and Wales in 10 Northern England Scotland Wales Ireland Did the patient die during the admitted under the care of a gastroenterologist? by an IBD nurse during their Was Anti TNF prescribed during the In patients started on Anti TNF during this admission, did they respond to this treatment? Was prophylactic Heparin prescribed? Were Standard Stool Culture (SSC) and Clostridium Difficile Toxin (CDT) samples requested, in patients with diarrhoea? by a dietician during the weighed during the What was the median (IQR) number of days between admission and surgery in nonelective patients? In patients undergoing surgery, was this undertaken laparoscopically? 17/26 (0.7%) 0/139 (0%) 3/168 (1.8%) 1/85 (0.5%) 842/2160 (39.0%) 32/123 (26.0%) 67/136 (49.3%) 40/141 (28.4%)* 786/2160 (36.4%) 5/123 (4.1%) 68/136 (50.0%) 46/141 (32.6%)* 168/36 (8.7%) 7/112 (6.3%) 3/127 (3.9%) 5/134 (3.7%) 148/168 (88.1%) 7/7 5/5 2/5 * 2285/26 (87.3%) 124/139 (89.2%) 145/168 (86.3%) 151/5 (81.6%) SSC 625/1028 (60.8%) CDT 560/1017 (55.1%) SSC 26/53 (49.1%) CDT 23/54 (42.6%) SSC 43/61 (70.5%) CDT 42/61 (69.9%) SSC 31/54 (57.4%) CDT 30/54 (55.6%)* 831/2160 (38.5%) 38/123 (30.9%) 60/136 (44.1%) 49/141 (34.8%) 1574/2160 (72.9%) 70/123 (56.9%) 116/136 (85.3%) 79/141 (56.0%)* 3 (1, 9) 8 (6, 9) 2 (1, 5) 2 (1, 5) 301/846 (35.6%) 14/30 (46.7%) /68 (29.4%) 26/76 (34.2%) Does the patient smoke? 780/26 (29.8%) 37/139 (26.6%) 51/168 (30.4%) 59/5 (31.9%) Royal College of Physicians 11 16

17 IBD clinical nurse specialist involvement with IBD inpatients Traditionally the resource of an IBD nurse has been mainly utilised in outpatient settings. More recently the work of the IBD nurse has begun to involve more interaction with IBD inpatients. The first national prospective IBD nurse audit was conducted by the Royal College of Nursing IBD Network Group in May 11. The executive report will be launched by the group in early 12 and will contain a detailed breakdown of IBD nurse specialist roles and skills. Readers are directed toward this document for further information pertaining to the detailed activities of the IBD nurse specialist. Table 7 below combines results from the clinical audit and organisational audit elements of the UK IBD audit 3rd round looking at clinical audit data from sites that indicated in the organisational audit that they had some (> 0) IBD nurse provision. The data suggests that at sites where there is an IBD nurse specialist, the nurse is more likely to see the patient if they are being started on anti TNF therapy during an admission. Table 7 IBD nurse specialist involvement in inpatient care Table 7: At sites which indicated in the 10 organisational audit element of the UK IBD audit 3rd round that they had > 0 IBD nurse provision: Was any patient (who was not receiving anti TNF therapy on admission) given anti TNF therapy during the admission and seen by an IBD nurse? Did the IBD nurse see the patient during the given anti TNF therapy during the No No 893 (57.9%) 34 (22.8%) p value Yes 649 (42.1%) 115 (77.2%) <0.001 Yes Invitation to join a writing group to conduct further analysis on the audit data The UK IBD Audit Steering Group would welcome approaches via ibd.audit@rcplondon.ac.uk to join a writing group that will be established to produce academic papers from the data collected from this 3rd round of the UK IBD audit. Suggested topics for further investigation of the audit data could include: An investigation into the trends in treatment of acute severe ulcerative colitis between 06 and 10 An investigation into the incidence of DVT in IBD inpatients An examination into the timeliness of surgical intervention in IBD patients: how are outcomes affected in cases with delayed surgical intervention? Laparoscopic versus non laparoscopic surgery in IBD An investigation into the medications provided to IBD inpatients Exploration of correlations between the provision of an IBD nurse specialist and treatment provided to inpatients Royal College of Physicians 11 17

18 Audit methodology The design of the audit was shaped to mainly investigate inpatient activity; it is worth noting however that the majority of care is known to be delivered in the outpatient setting. Datasets and standards used in the UK IBD audit (10) data collection process The datasets for this round of the UK IBD audit are, with minor adjustments, similar to those used in the 2nd round. These were agreed by the UK IBD Audit Steering Group as being appropriate to measure the processes of IBD care in line with the BSG Guidelines for the management of IBD in adults. Data collection tool The web tool included context specific online help including definitions and clarifications, internal logical data checks and feedback to enable more complete and accurate data. Security and confidentiality were maintained through the use of site specific codes and no patient identifiers were included in the datasets. Sites accessed the datasets by using a unique login and password and data could be saved during, as well as at the end of an input session. A telephone and helpdesk was provided by the Clinical Effectiveness & Evaluation Unit at the Royal College of Physicians in order to answer any individual queries about the audit. Recruitment Three individuals from each hospital were approached: a lead Clinician, lead surgeon and a lead from within the Clinical Audit Department. An overall audit lead (usually a consultant gastroenterologist) from each site was then identified following local discussion. This audit lead was responsible for ensuring the quality of data collection and entry for their particular site. Trust/Health Board Chief Executives were alerted to the audit. Hospitals were eligible to participate if they had a unified IBD Service within their hospital that routinely admitted IBD patients acutely. Audit data was entered onto the web tool between 1st September 10 and 31st August sites submitted clinical audit data. This encouraging level of participation was achieved through the hard work and time commitment of local clinical teams involved in the management of patients with IBD and in most cases with considerable assistance from their colleagues in clinical audit departments. In total, data were collected for 3049 ulcerative colitis patients (from 8 sites), and for 3122 Crohn s disease patients (from 8 sites). Data required To examine individual patient care, the case notes were to be audited of 40 consecutive inpatients ( Crohn s disease and ulcerative colitis) beginning with those patients discharged from 1st September 10 and continuing until 31st August 11, or until the full cohort of patients had been entered. Case identification was based on patients being aged 17 years or over at the date of admission with a discharge diagnosis of IBD, as this defined the standards a clinical team expects to be assessed against. A list of relevant ICD10 and OPCS codes was provided to aid patient identification. Inclusion and exclusion criteria Patients were to be included in the audit if the primary reason for their admission was because of IBD or symptoms that were later diagnosed with IBD and excluded if IBD was not the main reason for admission e.g. an IBD patient admitted with a myocardial infarction. Patients with indeterminate colitis were excluded as were those aged less than 17 years of age at admission. A separate paediatric UK IBD audit report has been produced investigating the care of patients admitted to specialist paediatric IBD units. Only those patients with a length of stay of greater than 24hours were audited, excluding day Royal College of Physicians 11

19 cases for endoscopy/infusion. Patients admitted more than once during the time period, were only audited once; the case for inclusion was that which occurred first chronologically. New components for the 3rd round For each complete admission audited, an inpatient and GP questionnaire were generated by the UK IBD audit web tool. These questionnaires were distributed by participating sites to all relevant inpatients and General Practitioners. Use of a unique cross reference code on the questionnaires allowed for anonymised linkage of questionnaire data with clinical data. The results of these questionnaires will be reported upon separately in April 12. For the first time the UK IBD audit includes a biologics audit aspect, data collection is currently ongoing and will be reported separately in June 12. Note on the term site used throughout the report Lead clinicians (in almost every instance a consultant gastroenterologist) that were initially contacted within each Trust/Health Board with a view to taking part in the UK IBD audit 3rd round, were asked to register to participate and collect data on the basis of a unified IBD Service which would be registered as a named site. This was typically a single hospital within the Trust/Health Board. Where a Trust/Health Board had more than one hospital offering independent IBD Services they entered data for separate sites. Some institutions running a coordinated IBD Service across two or more hospitals with the same staff completed the audit as one Trust/Health Board wide site. Audit governance The UK IBD audit (10) Report is a collaborative partnership between gastroenterologists (the British Society of Gastroenterology), colorectal surgeons (the Association of Coloproctology of Great Britain and Ireland), patients (Crohn s and Colitis UK), physicians (the Royal College of Physicians of London) together with paediatric gastroenterologists (The British Society of Paediatric Gastroenterology, Hepatology and Nutrition). This clinical report follows the publication by the UK IBD Audit Steering Group, of the National Organisational Audit of Adult IBD Services in the UK, in May 11. This enables sites to not only benchmark their provision of both service and care against national standards, but also to identify areas of improvement and monitor change from the previous round in 08. The audit is commissioned and funded by the Health Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) with additional funding from Health Improvement Scotland. The audit is co ordinated by the Clinical Effectiveness and Evaluation unit (CEEu) of the Royal College of Physicians of London. Each hospital identified an overall clinical lead that was responsible for data collection and entry for their IBD Service. Data were collected by hospitals using a standardised method. The audit was guided by the multidisciplinary UK IBD Audit Steering Group which oversaw the preparation, conduct, analysis and reporting of the audit. Any enquiries in relation to the work of the UK IBD audit can be directed to: ibd.audit@rcplondon.ac.uk Presentation of results in section 4 Wherever possible the 10 audit question numbers have been added within tables of results in section 4 to facilitate reference to the actual questions in the audit datasets as seen in Appendix 3. Section 4 provides a breakdown of the full 10 UK wide results. Local results will be shown alongside the UK data within the individualised site reports under the Your Site column Results are presented as percentages for categorical data and as median and inter quartile range (IQR) for numerical data. Royal College of Physicians 11

20 Section 4: Full 10 audit results full UK 10 results with your site comparison In total data were collected for 3049 ulcerative colitis patients (from 8 sites) with a median of per site, IQR (12 ). PRE SECTION PATIENT DEMOGRAPHICS n=3049 National Results 10 Auditor discipline Consultant 604/3049 % Other medical staff 1033/ % Nurse 1277/ % Manager 4/ % Clinical audit 253/3049 8% Other 159/3049 5% What was the patient s age at IQR Gender Female 1421/ % Male 1628/ % YOUR SITE 10 SECTION 1: ADMISSION / MORTALITY 1.1 ADMISSION n=3049 National Results 10 YOUR SITE What was the primary reason for a) Emergency admission for active ulcerative colitis 41/ % b) Planned admission for active ulcerative colitis 159/3049 5% c) Elective admission for surgery 481/ % d) New diagnosis of ulcerative colitis 430/ % e) Transferred from another site for surgery 14/ % f) Transferred from another site for further medical management 24/ % The rest of this table excludes elective admissions ie those where options c) or e) were chosen in Q1.1.2 n= Which specialty was responsible for the patient's care 24 hours after a) Acute Medicine 773/ % b) Gastroenterology 18/ % c) Colorectal Surgery 2/2554 7% d) Geriatrics / % e) General Medicine 139/2554 5% f) General Surgery 6/2554 8% g) Other 36/2554 1% What date was the patient first seen by a consultant gastroenterologist? Number of patients seen 2253/ % Days from admission (if seen) Not seen 1 210/2554 IQR 1 3 8% Not required 91/2554 4% What date was the patient first seen by a consultant colorectal surgeon? Number of patients seen 821/ % IQR Days from admission (if seen) Royal College of Physicians 11

21 Not seen 702/ % Not required 1031/ % Not seen by either consultant gastroenterologist or consultant colorectal 152/2515 6% surgeon by an IBD nurse specialist during the 1067/ % transferred to a specialist gastroenterology ward? 1737/ % 1.1.7i If yes, which type of ward? a) Medical 1502/ % b) Joint Medical/Surgical 141/1737 8% c) Surgical 94/1737 5% 1.2 COMORBIDITY n=3049 National Results 10 YOUR SITE Did the patient have any significant co morbid diseases? a) Heart Disease 283/3049 9% c) Respiratory 9/3049 7% e) Diabetes 212/3049 7% g) Liver Disease 34/3049 1% h) Active Cancer / % i) None 86/ % j) Other 539/3049 % 1.3 DISCHARGE / MORTALITY n=3049 National Results 10 YOUR SITE Did the patient die during 28/ % 1.3.1i Days from admission (if died) 13 IQR ii Primary cause of death a) Dementia 0/28 0% b) Cerebrovascular disease 0/28 0% c) Heart disease 3/ % d) Respiratory disease 6/ % e) Post operative complications 3/ % f) Renal failure 0/28 0% g) Pulmonary Embolism 0/28 0% h) Liver Disease 0/28 0% i) Gastrointestinal Bleeding 1/28 3.6% j) Other 15/ % 1.3.1i v Length of stay (if discharged) IQR days 95/3021 3% 2 days 151/3021 5% 3 6 days 952/ % 7 13 days 1099/ % days 515/ % 28 or more days 9/3021 7% 1.3.1v Discharge destination a) Discharged home 2982/ % b) Transferred to another site for surgery 4/ % c) Transferred to another site for further medical management 35/3021 1% Royal College of Physicians 11 21

22 SECTION 2: ASSESSING THE SEVERITY OF ULCERATIVE COLITIS Elective cases [where in Q1.1.2 c) or e)were chosen] are excluded from all of section 2 PATIENT HISTORY n=2554 National Results 10 YOUR SITE Did the patient have a pre admission diagnosis of ulcerative colitis? 02/ % What was the extent of the colitis? a) Proctitis (E1) 248/02 12% b) Left sided (E2) 795/02 40% c) Extensive (E3) 215/02 11% d) Pan Colitis (E4) 474/02 24% e) unknown 270/02 13% Has the patient had previous admissions with ulcerative colitis in the two years prior to this 656/02 33% 2.1.3i Number of admissions in the two years prior to this SEVERITY OF DISEASE n=2554 National Results 10 YOUR SITE How many loose or bloody stools were passed in the first full day following No loose or bloody stools 52/2554 2% 1 or more loose or bloody stools 37/ % IQR Not documented 528/ % Not required 37/2554 1% What was the highest recorded pulse rate during the first full day following (BPM) 90 IQR Not documented What was the highest temperature recorded during the first full day following ( o C) N 100/ N 116/2554 IQR 1 2 % 3% IQR Not documented In patients with 1 or more loose or bloody stools (Q2.2.1) Was a stool sample sent for Standard Stool Culture? 1537/37 79% NA 32/37 2% IQR 2.2.4i Days from admission until sample sent ii Was it positive? 33/1537 2% IQR 2.2.4iii Days between sample sent and reported positive In patients with 1 or more loose or bloody stools (Q2.2.1) Was a stool sample sent for CDT? 1414/37 73% NA 62/37 3% IQR 2.2.5i Days from admission until sample sent ii Was it positive? 22/1414 2% IQR 2.2.5iii Days between sample sent and reported positive % 4% Royal College of Physicians 11 22

23 2.3 MONITORING OF COLITIS n=2554 National Results 10 YOUR SITE Was a plain abdominal X Ray performed? 2216/ % IQR 2.3.1i Time from admission to request ii Time from admission to x ray iii Time from admission to report by radiologist Was toxic megacolon present in the x ray? Yes 58/2216 3% 2.3.2i Was a repeat x ray or CT Scan or MRI Scan performed? 52/58 90% IQR 2.3.2ii Time from admission to repeat x ray SECTION 3: MEDICAL INTERVENTIONS 3.1 USE OF ANTI THROMBOTIC THERAPY n=3049 National Results 10 YOUR SITE Did the patient have a thrombotic episode during this 66/3049 2% given prophylactic heparin? 2668/ % Section 3.2 excludes elective cases [Where in Q1.1.2 option c) or e) were chosen] 3.2 STEROID THERAPY n=2554 National Results 10 YOUR SITE Were corticosteroids administered during this 2292/ % a) iv corticosteroids initially prescribed / % b) oral corticosteroids initially prescribed 372/ % Which of the following steroids were prescribed? a) Prednisolone 376/ % b) Methylprednisolone 107/2292 5% c) Budesonide 3/ % d) Hydrocortisone 06/ % IQR 3.2.2i Initial steroid dose (mg/day) ii Time from admission to initiation iii Was therapy increased during this 150/2292 7% IQR 3.2.2iv Time from admission to increase Did the patient respond to corticosteroids and not require any other significant therapy for ulcerative colitis? 1529/ % 3.3 WHICH OTHER THERAPIES DID THE PATIENT RECEIVE? The denominator for the findings below (Q3.3.1 Q3.3.4)has been calculated to include the 763 cases where corticosteroids were prescribed but there was no response to this treatment (Q3.2.3) and the 262 cases where a patient was not recorded as receiving corticosteroids (Q3.2.1) n=1025 National Results 10 YOUR SITE Received Ciclosporin therapy 237/ % 3.3.1ii Did the patient respond? 149/237 63% IQR 3.3.1i Time between admission and starting treatment Received Anti TNF therapy 168/ % 3.3.2ii Did the patient respond? 140/168 83% IQR 3.3.2i Time between admission and starting treatment Royal College of Physicians 11 23

24 3.3.3 Received therapy as part of a clinical trial 43/1025 4% 3.3.3iii Did the patient respond? 33/43 77% IQR 3.3.3ii Time between admission and starting treatment Received other significant therapy 265/ % 3.3.4ii Did the patient respond? 224/265 85% Section 3.4 excludes elective cases [Where in Q1.1.2 option c) or e) were chosen] 3.4 RESPONSE TO TREATMENT n=2554 National Results 10 YOUR SITE 10 DAY 1 LOS = >0 (n=2554) a) Frequency of loose or bloody stools on Day 1 51/ % IQR Not documented 556/ % Not applicable 47/2554 2% b) Albumin on Day / % IQR Not documented 421/ % c) CRP on Day 1 60/ % IQR Normal 174/2539 7% Not documented 3/ % DAY 2 LOS = >1 (n=2539) a) Frequency of loose or bloody stools on Day / % IQR Not documented 775/ % Not applicable 54/2539 2% b) Albumin on Day / % IQR Not documented 1527/ % c) CRP on Day / % IQR Normal 138/2539 5% Not documented 1275/ % DAY 3 LOS = >2 (n=2464) a) Frequency of loose or bloody stools on Day 3 16/ % IQR Not documented 786/ % Not applicable 59/2464 3% Royal College of Physicians 11 24

25 b) Albumin on Day / % IQR Not documented 1306/ % c) CRP on Day / % IQR Normal 160/2464 6% Not documented 1040/ % DAY 4 LOS = >3 (n=2321) a) Frequency of loose or bloody stools on Day / % IQR Not documented 759/ % Not applicable 68/2321 3% b) Albumin on Day / % IQR Not documented 1165/ % c) CRP on Day / % IQR 7 49 Normal 2/2321 8% Not documented 873/ % SECTION 4: SURGICAL INTERVENTIONS Site level results will be provided split by elective and emergency admissions based on admission reason provided in Q Cases noted as transferred to another site for surgery are excluded (Q1.3.1v) from all of the Section 4 tables 4.1 SURGICAL THERAPY n=3045 National Results 10 National Results 10 EMERGENCY ELECTIVE ADMISSIONS ADMISSIONS n=495 n= Did the patient have surgery on this 490/495 99% 317/ % IQR IQR Time from admission to surgical decision 55 98, Time from admission to surgery Was there a delay of more than 24 hours between decision to operate and surgery for non elective patients? N 33/490 % 7% N 70/ i Reason for delay a) Improvement in severity of UC 0/33 0% 9/70 13% b) Cancelled due to lack of theatre time 2/33 6% 14/70 % c) Cancelled for other clinical reasons 2/33 6% 8/70 11% d) Patient declined surgery or needed time to consider 6/33 % /70 26% e) Other 23/33 70% 21/70 30% by a stoma nurse during this 338/490 69% 286/317 90% IQR IQR % 22% Royal College of Physicians 11 25

26 4.1.5i Time from admission to seeing stoma nurse What was the grade of the senior surgeon present? a) Consultant colorectal surgeon 471/490 96% 274/317 86% b) Consultant GI surgeon (non colorectal) 3/ % 8/317 3% c & d) Other consultant surgeon 7/490 1% 14/317 4% e & f) SpR or Associate specialist 8/490 2% /317 6% g) Other 1/ % 1/ % What were the indications for surgery? a) Failure of Medical Therapy 252/490 51% 277/317 87% b) Toxic megacolon 2/ % 34/317 11% c) Bleeding 13/490 3% 25/317 8% d, j or k) Obstruction, abscess or perforation 6/490 1% /317 6% e) Completion Proctectomy 123/490 25% 2/ % f, g or h) Dysplasia (any grade) 28/490 6% 2/ % i) Cancer 6/490 1% 1/ % l) Formation of Ileostomy 41/490 8% /317 6% m) Closure of stoma 39/490 8% 2/ % n) Other indication 70/490 14% 26/317 8% Type of intervention a) Subtotal colectomy 142/490 29% 252/317 80% b) Protocolectomy 103/490 21% 25/317 8% c) Proctectomy 102/490 21% 4/317 1% d) Ileoanal pouch with stoma 106/490 22% 7/317 2% e) Ileoanal pouch without stoma 44/490 9% 3/317 1% f) Formation of Ileostomy 139/490 28% 157/317 50% g) Other 74/490 15% 34/317 11% 4.1.8i Was the surgery done laparoscopically / laparoscopically assisted? N 5/490 % 42% N 98/317 % 31% Was the ASA status recorded pre operatively? Yes 338/490 69% 216/317 68% 1 85/338 25% 32/216 21% 2 3/338 60% 105/216 49% 3 40/338 12% 80/216 37% 4 6/338 2% 7/216 3% 5 0/338 0% 1/ % NA 4/338 1% 2/216 1% 4.2 SURGICAL COMPLICATIONS EMERGENCY ELECTIVE ADMISSIONS ADMISSIONS Did the patient suffer from any of these complications following their surgery? a) Wound Infection 36/490 7% 32/317 10% b) Rectal stump complications 7/490 1% 12/317 4% c) Intra abdominal bleeding 8/490 2% 3/317 1% d) Intra abdominal sepsis 23/490 5% /317 6% e) Anastomotic leakage 6/490 1% 4/317 1% f) Stoma complications 13/490 3% 14/317 4% g) Deep vein thrombosis 2/ % 1/ % h) Pulmonary embolus 0/490 0% 3/317 1% i) Ileus requiring TPN 13/490 3% 7/317 2% j) Small bowel obstruction 14/490 3% 17/317 5% k) Cardiac 6/490 1% 9/317 3% l) Respiratory 13/490 3% 25/317 8% m) Clostridium difficile associated diarrhoea 0/490 0% 0/317 0% n) No Complications 326/490 67% 0/317 57% o) Other 81/490 17% 47/317 15% Royal College of Physicians 11 26

27 SECTION 5: DISCHARGE ARRANGEMENTS Section 5 excludes any deceased patients and those recorded as transferred to another site for surgery or further medical management in Q DISCHARGE ARRANGEMENTS N=2982 National Results 10 YOUR SITE taking oral steroids on discharge? 24/ % Was a steroid reduction programme stated on discharge for those patients receiving steroids? 48/24 93% Were bone protection agents prescribed in those taking steroids on discharge? 1443/24 66% Was patient on immunosupressives on discharge? 748/ % Was there a plan for maintenance Anti TNF on discharge? 174/2980 6% Royal College of Physicians 11 27

28 Crohn s disease full UK 10 results with your site comparison In total data were collected for 3122 Crohn s disease patients (from 6 sites) with a median of per site, IQR (12 ). PRE SECTION PATIENT DEMOGRAPHICS National Results 10 YOUR SITE 10 Auditor discipline Consultant 631/3122 % Other medical staff 1021/ % Nurse 1325/ % Manager 1/ % Clinical audit 268/3122 9% Other 175/3122 6% What was the patient s age at IQR Gender Female 1784/ % Male 1338/ % SECTION 1: ADMISSION / MORTALITY 1.1 ADMISSION N=3122 National Results 10 YOUR SITE What was the primary reason for a) Emergency admission for active Crohn s disease 38/ % b) Planned admission for active Crohn s disease 0/3122 6% c) Elective admission for surgery 543/ % d) New diagnosis of Crohn s disease 336/ % e) Transferred from another site for surgery 8/ % f) Transferred from another site for further medical management 17/ % The rest of this table excludes elective admissions i.e. those where options c) or e) were chosen in Q1.1.2 n= Which specialty was responsible for the patient's care 24 hours after a) Acute Medicine 585/ % b) Gastroenterology 983/ % c) Colorectal Surgery 421/ % d) Geriatrics 3/ % e) General Medicine 126/2571 5% f) General Surgery 414/ % g) Other 39/2571 2% What date was the patient first seen by a consultant gastroenterologist? Number of patients seen 94/ % Days from admission (if seen) IQR Not Seen 410/ % Not required 167/2571 7% What date was the patient first seen by a consultant colorectal surgeon? Number of patients seen 1098/ % IQR Days from admission (if seen) Not seen 626/ % Not required 847/ % *Patients who were not seen by either consultant gastroenterologist or consultant colorectal surgeon 7/2571 8% Royal College of Physicians 11 28

29 1.1.6 by an IBD nurse specialist during the 905/ % transferred to a specialist gastroenterology ward? 1553/ % 1.1.7i If yes, which type of ward? a) Medical 1145/ % b) Joint Medical/Surgical 143/1553 9% c) Surgical 265/ % 1.2 COMORBIDITY N=3122 National Results 10 YOUR SITE Did the patient have any significant co morbid diseases? a) Heart Disease 154/3122 5% c) Respiratory 223/3122 7% e) Diabetes 105/3122 3% g) Liver Disease 23/ % h) Active Cancer 10/3122 0% i) None 2328/ % j) Other 481/ % 1.3 DISCHARGE / MORTALITY N=3122 National Results 10 YOUR SITE Did the patient die during 21/ % IQR 1.3.1i Days from admission (if died) ii Primary cause of death a) Dementia 0/21 0% b) Cerebrovascular disease 0/21 0% c) Heart disease 0/21 0% d) Respiratory disease 3/21 14% e) Post operative complications 7/21 33% f) Renal failure 0/21 0% g) Pulmonary Embolism 0/21 0% h) Liver Disease 0/21 0% i) Gastrointestinal Bleeding 0/21 0% j) Other 11/21 52% 1.3.1iv Length of stay (if discharged) IQR days 152/3122 5% 2 days 253/3122 8% 3 6 days 1110/ % 7 13 days 955/ % days 383/ % 28 or more days 215/3122 7% 1.3.1v Discharge destination a) Discharged home 3071/ % b) Transferred to another site for surgery 8/ % c) Transferred to another site for further medical management 22/ % Royal College of Physicians 11 29

30 1.4 MEDICATION ON ADMISSION N=3122 National Results 10 YOUR SITE What treatment was the patient taking for Crohn s disease on (multiple options could be chosen) a) 5 ASA 1073/ % b) Azathioprine 749/ % c) Mercaptopurine 113/3122 4% d) Methotrexate 100/3122 3% e) Antibiotics 89/3122 3% f) Corticosteroids 871/ % g) Dietary Therapy 2/ % h) anti TNF α 303/ % i) None 954/ % j) Other 135/3122 4% In the 12 months prior to admission was the patient taking steroids (at any time) for >3 months? 664/ % 1.4.2i If yes, was an appropriate dose reduction planned? 600/664 90% 1.4.2ii If yes, was bone protection used? 404/664 61% 1.4.2iii Was a DEXA scan done? 132/664 % 1.5 SMOKING STATUS N=3122 National Results 10 YOUR SITE What was the smoking status of the patient? a) Current smoker 931/ % b) Lifelong non smoker/ ex smoker 1783/ % c) Not documented 408/ % 1.6 PATIENT HISTORY N=3122 National Results 10 YOUR SITE Did the patient have a pre admission diagnosis of Crohn s disease? 2671/ % What was the extent of the disease? a) Terminal ileum (L1) 953/ % b) Colonic (L2) 741/ % c) Ileo colonic (L3) 902/ % d) Perianal 244/2671 9% e) upper GI (L4) 81/2671 3% f) Not known 2/2671 8% Has the patient had previous admissions to your hospital with Crohn s disease in the two years prior / % to this 1.6.3i Number of admissions in the two years prior to this IQR SECTION 2: ASSESSING THE SEVERITY OF CROHN S DISEASE 2.1 INITIAL ASSESSMENT DURING FIRST FULL DAY National Results 10 YOUR SITE 10 FOLLOWING ADMISSION N= Number of liquid stools during the first full day following admission No liquid stools 1 or more liquid stool Not documented 264/ / / % 51% 22% Not required 4/ % General well being Well 104/2571 4% Mild symptoms 367/ % Moderate symptoms 1268/ % Royal College of Physicians 11 30

31 Severe symptoms 708/ % Not documented 124/2571 5% Abdominal pain None 268/ % Present 2272/ % Not documented 31/2571 1% Abdominal mass None 2106/ % Present 242/2571 9% Not documented 223/2571 9% Did the patient report any of the following complications? Mouth ulcers 107/2571 4% Arthralgia 0/2571 8% Pyoderma Gangrenosum 7/ % Anal fissure 70/2571 3% Fistula 174/2571 7% Erythema Nodosum 35/2571 1% Abscess 142/2571 6% Iritis 17/ % Other 111/2571 4% Admission results for: IQR 2.1.6i CRP (mg/l) Not documented 136/2571 4% 2.1.6ii Hb (g/dl) IQR Not documented 63/2571 2% 2.1.6iii Albumin (g/l) IQR Not documented 221/2571 7% 2.2 EXCLUSIVE OF INFECTION N=1309 National Results 10 YOUR SITE 10 In patients with >1 liquid stool (Q 2.1.1) on first full day Was a stool sample sent for Standard Stool Culture? Not applicable 726/ / % 8% IQR 2.2.1i Days from admission until sample sent ii Was it positive? 7/726 1% IQR 2.2.1iii Days from sample sent until reported positive Was a stool sample sent for CDT? Not applicable 657/ / i Days from admission until sample sent ii Was it positive? 7/657 1% IQR 2.2.2iii Days from sample sent until reported positive WEIGHT ASSESSMENT AND DIETETIC SUPPORT DURING ADMISSION N=2571 National Results 10 YOUR SITE s weight measured during admission 46/ % 2.3.1i Was BMI measured 1215/46 66% Did a dietician see the patient? 980/ % Was dietary treatment initiated? 783/ % 2.3.3i Was exclusive liquid enteral nutrition therapy prescribed? 165/783 21% 50% 9% IQR Royal College of Physicians 11 31

32 2.3.3ii Was supplemental liquid enteral nutrition therapy 558/783 71% prescribed? Was parenteral nutrition given? 138/2571 5% SECTION 3: MEDICAL INTERVENTIONS 3.1 USE OF ANTI THROMBOTIC THERAPY N=3122 National Results 10 YOUR SITE Did the patient have a thrombotic episode during this 59/3122 2% given prophylactic heparin? 2708/ % 3.2 STEROID THERAPY N=2571 National Results 10 YOUR SITE Were corticosteroids administered during this 25/ % a) iv corticosteroids initially prescribed 1317/25 72% b) oral corticosteroids initially prescribed 508/25 28% Which of the following steroids were prescribed? a) Prednisolone 456/25 25% b) Budesonide 88/25 5% c) Hydrocortisone 1216/25 67% d) Methylprednisolone 65/25 4% 3.2.2i Initial dose (mg/day) IQR 3.2.2ii Time to initial dose from admission (days) iii Was therapy increased during this 112/25 6% 3.2.2iv Time to increase in therapy from admission (days) WHICH OTHER THERAPIES DID THE PATIENT RECEIVE N=2571 National Results 10 YOUR SITE Received Anti TNF therapy 248/ % 3.3.1i Time to admission to starting treatment ii Did the patient respond? 2/248 88% Received therapy as part of a clinical trial 13/ % 3.3.2ii Time to admission to starting treatment iii Did the patient respond? 9/13 69% Received other significant therapy 366/ % 3.3.3ii Did the patient respond? 313/366 86% SECTION 4: SURGICAL INTERVENTIONS Site level results will be provided split by elective and emergency admissions based on admission reason provided in Q Patients transferred to another site for surgery are excluded (Q1.3.1v) from all of the Section 4 tables 4.1 SURGICAL THERAPY National Results 10 National Results 10 Non ELECTIVE ELECTIVE ADMISSIONS ADMISSIONS n=550 n= Did the patient have surgery on this 546/550 99% 474/2564 % Time from admission to surgical decision 34 IQR 61, 14 2 IQR Time from admission to surgery Was there a delay of more than 24 hours between decision to operate and surgery for non elective 29/546 5% 78/474 16% patients? 4.1.4i Reason for delay a) Improvement in severity of Crohn s 2/29 7% 8/78 10% b) Cancelled due to lack of theatre time 3/29 10% 23/78 29% c) Cancelled for other clinical reasons 1/29 3% 8/78 10% d) Patient declined surgery or needed time to consider 5/29 17% 7/78 9% Royal College of Physicians 11 32

33 e) Other /29 62% 32/78 41% by a stoma nurse during this N 163/546 % 30% N 3/474 % 43% 4.1.5i Time from admission to seeing stoma nurse (days) 1 IQR IQR What was the grade of the senior surgeon present? a) Consultant colorectal surgeon 512/546 94% 352/474 74% b) Consultant GI surgeon (non colorectal) 15/546 3% 31/474 7% c & d) Other consultant surgeon 9/546 2% 37/474 8% e & f) SpR or Associate specialist 10/546 2% 44/474 9% g) Other 0/546 0% 10/474 2% What were the indications for surgery? a) Failure of Medical Therapy 254/546 47% 141/474 30% b) Toxic megacolon 0/546 0% 10/474 2% c) Bleeding 3/ % 9/474 2% d, j or k) Obstruction, abscess or perforation 172/546 32% 295/474 62% e) Completion Proctectomy 27/546 5% 1/ % f, g or h) Dysplasia (any grade) 6/546 1% 0/474 0% i) Cancer 5/ % 2/ % l) Formation of Ileostomy /546 3% 27/474 6% m) Closure of stoma 29/546 5% 1/ % n) Other indication 0/546 33% 106/474 22% Type of intervention a) Segmental/Extended Colectomy 51/546 9% 59/474 12% b) Subtotal Colectomy 25/546 5% 61/474 13% c) Protocolectomy 27/546 5% 3/ % d) Stricturoplasty 25/546 5% 11/474 2% e) Ileal/Jejunal Resection 66/546 12% 49/474 10% f) Resection of Intra abdominal fistula 29/546 5% 14/474 3% g) Proctectomy 15/546 3% 1/ % h) Completion Proctectomy 16/546 3% 1/ % i) Ileocolonic Resection 211/546 39% 150/474 32% j) Drainage of abscess 9/546 2% 76/474 16% k) Formation of Ileostomy or colostomy 69/546 13% 105/474 22% l) Revision of Stoma 11/546 2% 6/474 1% m) Perineal procedure 6/546 1% 11/474 2% n) Closure of Stoma 27/546 5% 1/ % o) Division of adhesions 26/546 5% 31/474 7% p) Other intervention 112/546 21% 75/474 16% 4.1.8i Was the surgery done laparoscopically/laparoscopically assisted? N 379/546 % 69% N 102/474 % 22% Was the ASA status recorded pre operatively? Yes 379/546 69% 297/474 63% 1 71/379 % 55/297 % 2 246/379 65% 154/297 52% 3 49/379 13% 66/297 22% 4 5/379 1% 15/297 5% 5 0/379 0% 3/297 1% NA 8/379 2% 4/297 1% 4.2 SURGICAL COMLPICATIONS National Results 10 ELECTIVE ADMISSIONS n= National Results 10 Non ELECTIVE ADMISSIONS n= Did the patient suffer from any of these complications following their surgery? a) Wound Infection 40/546 7% 28/474 6% b) Rectal stump complications 0/546 0% 2/ % Royal College of Physicians 11 33

34 c) Intra abdominal bleeding 8/546 1% 5/474 1% d) Intra abdominal sepsis 21/546 4% 42/474 9% e) Anastomotic leakage 15/546 3% 17/474 4% f) Stoma complications 8/546 1% 9/474 2% g) Deep vein thrombosis 1/ % 2/ % h) Pulmonary embolus 3/ % 3/ % i) Ileus requiring TPN 13/546 2% 16/474 4% j) Cardiac 7/546 1% 5/474 1% k) Respiratory 16/546 3% 29/474 6% l) Clostridium difficile associated diarrhoea 0/546 0% 1/ % m) Other 61/546 11% 43/474 9% n) No complications 386/546 71% 341/474 72% 4.3 Non ELECTIVE POST OPERATIVE PROPHYLACTIC THERAPY ELECTIVE ADMISSIONS ADMISSIONS prescribed any of the following drugs on discharge? a) Azathioprine 114/546 21% 78/474 16% b) Mercaptopurine 13/546 2% 9/474 2% c) Metronidazole 31/546 6% 26/474 6% d) 5 ASA 107/546 % 88/474 % e) Methotrexate 10/546 2% 4/ % f) Infliximab 9/546 2% 15/474 3% g) Other 68/546 12% 87/474 % h) None 279/546 51% 239/474 50% SECTION 5: DISCHARGE ARRANGEMENTS 5.1 DISCHARGE ARRANGEMENTS N=3071 National Results 10 YOUR SITE taking oral steroids on discharge? 1763/ % 5.1.1i Was a steroid reduction programme stated on discharge? 1538/ % 5.1.1ii Were bone protection agents prescribed? 1022/ % Was patient on immunosupressives on discharge? 1054/ % Was there a plan for maintenance Anti TNF on discharge? 481/ % SECTION 6: OUTPATIENT VISITS 6.1 PATIENT HISTORY N=3122 National Results 10 YOUR SITE Did the patient have previous outpatient visits for Crohn s disease at this hospital in the 12 months 2117/ % prior to this How many times was the patient reviewed for their IQR Crohn s disease in an outpatient s clinic in the 12 months prior to the start date of this Approximately how many times was the patient seen by the following staff in the 12 months prior to the start date of this a) Consultant b) IBD nurse specialist c) Specialist registrar d) F2 (SHO) Royal College of Physicians 11 34

35 Section 5: Individual site 10 key indicator data The table in this section gives named site data in alphabetical order of participating site. These data items were agreed by the UK IBD Audit Steering Group as reflecting the questions of particular importance to IBD patients. The combined UK results from all 8 participating sites are shown for comparison. These results should be interpreted within the context of the fact that many sites entered a relatively small number of cases to the audit and therefore percentages should be reviewed alongside actual numbers of cases submitted. Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Chesterfield Royal Hospital (83%) 3 (60%) 2 (25%) East Midlands SHA Kettering General Hospital (92%) 4 (80%) 8 4 Lincoln County Hospital (47%) 7 1 Northampton General Hospital (60%) 6 (60%) 0 (0%) Nottingham University Hospital NHS trust (Queen's Medical Centre & Nottingham City Hospital Combined) (93%) 16 (89%) 12 (92%) 7 (78%) Pilgrim Hospital 16 9 (75%) 14 (82%) 4 1 (33%) (86%) 17 (85%) 10 (71%) 16 (80%) 11 (69%) 6 12 (71%) 13 (81%) (72%) (75%) 16 (89%) 5 (28%) 3 (75%) 6 (46%) 1 (33%) 0 (0%) 0 (0%) 2 (40%) 7 (78%) 7 (64%) 5 (33%) 9 (60%) 6 (75%) 2 (25%) 2 (29%) 7 (70%) 2 (%) 6 (67%) 2 (14%) 2 (14%) 15 (83%) 7 (39%) 2 (25%) 3 (30%) 1 (8%) 9 (53%) 6 (35%) Royal College of Physicians 11 35

36 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Royal Derby Hospital (93%) 13 (81%) 8 (62%) 3 (50%) Sherwood Forest Hospitals NHS Foundation Trust (King's Mill Hospital & Newark Hospital Combined) University Hospitals of Leicester NHS Trust (Leicester Royal Infirmary and Leicester General Combined) (64%) 3 (75%) 16 (94%) 10 (59%) 7 (54%) 4 (50%) 15 (83%) 17 (85%) East of England SHA Addenbrooke's Hospital (85%) (89%) 17 (85%) 3 (75%) 8 (53%) 6 (55%) 14 8 (50%) 1 (33%) 13 (87%) 10 (83%) 7 (50%) 3 (21%) 2 (67%) 9 (60%) 4 (27%) 15 7 (41%) 8 (89%) 15 (83%) 12 (80%) 11 (61%) Basildon Hospital 17 (89%) 17 (94%) 7 (78%) 3 (60%) 3 (15%) 4 (%) 0 (0%) 3 (21%) 3 (21%) 17 (94%) 2 (11%) Bedford Hospital (83%) 12 (92%) 2 (40%) Broomfield Hospital (84%) 12 (75%) 10 (91%) 3 (60%) Colchester General Hospital 10 (91%) 11 (69%) 4 (57%) 7 East and North Hertfordshire NHS Trust (Lister Hospital & Queen Elizabeth II Hospital Combined) 14 (82%) 12 (75%) 12 (75%) 4 (36%) Royal College of Physicians (85%) 6 17 (85%) 4 (57%) 11 (85%) 2 (40%) 6 5 (83%) 3 (75%) 10 (59%) 3 (43%) 7 (44%) 5 (31%) 2 (40%) 8 (73%) 9 (69%) 15 (94%) 4 (25%) 4 (67%) 14 (82%) 6 (75%) 14 6 (38%)

37 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Hinchingbrooke Hospital (91%) 13 (76%) 7 (78%) 6 (86%) Ipswich Hospital 15 (94%) 13 (81%) 11 (73%) 4 (80%) James Paget Hospital (78%) 12 9 Luton & Dunstable Hospital 16 (89%) 11 (65%) 12 (92%) 3 (60%) Norfolk & Norwich University Hospital Peterborough City Hospital (prev Peterborough district hosp until Nov 10) Princess Alexandra Hospital, Harlow 14 (78%) 15 (83%) 7 (64%) (50%) 14 (78%) 14 (78%) 11 (61%) 2 (%) Queen Elizabeth Hospital (86%) 8 (57%) 0 (0%) West Hertfordshire Hospitals NHS Trust (Watford General Hospital & Hemel Hempstead General Hospital Combined) 9 14 (93%) 6 (86%) West Suffolk Hospital (67%) 4 (80%) (81%) 15 (75%) 15 (79%) 5 16 (80%) 14 (70%) 9 1 (33%) 8 (80%) 7 (50%) 11 (65%) 2 (12%) 0 (0%) 13 (76%) 12 (75%) 13 (81%) 8 (50%) 6 (86%) 5 (36%) 5 (33%) 12 (67%) 7 (39%) 4 (67%) 12 (86%) 10 (91%) 15 7 (41%) 7 (70%) 6 (38%) 1 (8%) 14 (78%) 6 (33%) 4 (80%) 8 (42%) 3 (25%) (69%) 2 (67%) 9 (53%) 7 (44%) 8 (44%) 5 (28%) 4 (80%) 7 (39%) 0 (0%) 6 (86%) 5 (71%) 3 (50%) 11 (65%) 7 (78%) 5 (50%) 1 (10%) 4 (80%) 0 (0%) 0 (0%) 1 (%) 4 (80%) 3 (60%) Royal College of Physicians 11 37

38 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Barnet General Hospital (87%) 11 (61%) 11 (85%) 6 (46%) Central Middlesex Hospital (94%) 4 12 (86%) 0 (0%) London SHA 11 (69%) 15 (94%) 17 (94%) 1 (50%) 11 (79%) 7 (54%) 14 (78%) 5 (28%) 3 (75%) 2 (50%) 8 (67%) 3 (75%) 4 0 (0%) Chelsea & Westminster Hospital (83%) 10 (83%) 5 (83%) 1 (%) 8 (89%) 7 (50%) 0 (0%) 3 (75%) 7 (78%) 6 (50%) 3 (25%) Ealing Hospital (67%) 2 (67%) 1 6 (75%) 4 (67%) 0 (0%) 4 (67%) 0 (0%) 2 (33%) 2 (33%) Epsom General Hospital (50%) 2 (50%) Guy's & St Thomas' NHS Foundation Trust (Guy's & St Thomas' Hospitals Combined) 5 (83%) 8 (89%) 3 1 (17%) Hillingdon Hospital (82%) 11 (85%) 6 (67%) Homerton University Hospital 10 7 (70%) 13 (76%) 6 (86%) 9 (82%) Imperial College Healthcare NHS Trust (Charing Cross, Hammersmith and St Mary's Hospitals Combined) (70%) 8 (57%) 10 (63%) 6 (86%) 3 10 (86%) 5 (83%) 1 0 (0%) 0 (0%) 4 1 (25%) 16 (94%) 0 (0%) 2 (67%) 2 8 (89%) 5 (56%) 2 (33%) 9 (60%) 3 (33%) 15 7 (41%) 3 7 (70%) 10 (71%) 16 (94%) 9 (53%) 2 (%) 11 (73%) 6 (75%) 4 (29%) 6 (43%) Royal College of Physicians 11 38

39 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) King George Hospital (72%) 3 (30%) 12 (92%) 3 (50%) King's College Hospital 16 (89%) 12 (92%) 14 (82%) 10 Kingston Hospital 14 (70%) 14 (78%) 12 (63%) 6 (46%) Mayday Hospital (78%) 4 (67%) 3 (38%) Newham University Hospital (87%) 5 9 (75%) 1 (50%) North Middlesex University Hospital North West London Hospitals NHS Trust (St Mark's & Northwick Park Hospitals Combined) Queen Elizabeth Hospital, Woolwich 17 (85%) 15 (75%) 17 (89%) 7 (54%) (91%) 12 (92%) 9 6 (55%) 10 (91%) 14 (93%) (80%) 0 (0%) 12 (75%) 3 (75%) 5 (50%) 3 (30%) 3 (50%) 11 (69%) 7 (70%) 12 (92%) 7 (54%) 3 (23%) 13 (76%) 7 (78%) 14 (78%) 11 (61%) 8 (89%) 1 (33%) 10 (91%) 7 3 (33%) 4 (44%) 5 0 (0%) 11 (79%) 2 (67%) 3 (60%) 3 (60%) 2 (33%) 16 (94%) 4 (44%) 9 (45%) 6 (30%) 2 (50%) 12 (86%) 12 (92%) (77%) (50%) 5 (71%) 2 (50%) 1 (%) 3 (75%) 6 (86%) 0 (0%) (57%) 3 (43%) Queens Hospital 17 (89%) 13 (76%) 11 (79%) 6 (67%) Royal Free Hospital (76%) 17 (85%) 1 (50%) 12 (71%) 8 (67%) 6 (35%) 6 (35%) 6 (60%) 15 (94%) 16 (80%) 5 (25%) Royal College of Physicians 11 39

40 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Royal London Hospital (80%) St George's Hospital 11 (85%) 13 (81%) 8 (80%) 6 (55%) 12 St Helier Hospital (80%) 7 (64%) The Lewisham Hospital NA 1 NA University College Hospital (71%) 11 (92%) 11 (92%) 7 (70%) West Middlesex Hospital (93%) 11 (79%) 11 (92%) 6 (67%) Whipps Cross University Hospital (91%) 12 (71%) 8 (42%) Whittington Hospital (82%) 9 14 (93%) 4 (44%) County Durham & Darlington NHS Foundation Trust (Darlington Memorial Hospital and Bishop Auckland Hospital Combined) (87%) 4 (67%) 11 2 (67%) North East SHA 16 (94%) 15 (75%) 11 4 (80%) 10 3 (50%) 12 (71%) 12 (71%) 1 (10%) 10 (91%) 7 (54%) 11 (69%) 8 (50%) 4 (57%) 7 4 (44%) 4 (36%) 3 (27%) NA 1 0 (0%) NA NA NA 11 (92%) (96%) 11 (85%) 11 3 (38%) 6 (60%) 1 (14%) 8 (67%) 8 (67%) 1 (13%) 12 (80%) 9 12 (86%) 5 (36%) 2 (50%) (85%) 22 5 (23%) 3 (38%) 11 (79%) 3 (38%) 10 4 (40%) 1 (11%) 3 (33%) (67%) Royal College of Physicians 11 40

41 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Freeman Hospital 16 8 (89%) 9 (75%) 2 (25%) 2 (40%) (85%) 3 7 (70%) 7 (54%) 7 (58%) 1 (8%) Friarage Hospital (62%) 6 (86%) 5 (63%) 3 (75%) 8 (62%) 6 (75%) 0 (0%) 3 (30%) 3 (50%) 5 (71%) 2 (29%) James Cook University Hospital (83%) 6 (60%) 7 (54%) North Tyneside General Hospital (89%) 7 (78%) 7 1 (33%) Queen Elizabeth Hospital, Gateshead Royal Victoria Infirmary, Newcastle (0%) 12 (80%) 16 (89%) 11 (85%) 4 (57%) South Tyneside District Hospital (73%) 13 (93%) 5 (71%) 4 (80%) Sunderland Royal Hospital 9 3 (75%) 13 (93%) 1 10 (83%) University Hospital of Hartlepool (67%) University Hospital of North Durham (83%) 5 (63%) 4 (80%) 0 (0%) (80%) 17 (85%) 2 13 (93%) 4 (57%) 2 (13%) 3 (17%) 16 (89%) 6 (33%) 1 (33%) 10 (91%) 4 (80%) 5 (56%) 3 (33%) 1 0 (0%) (60%) 11 (92%) 8 (89%) 14 (78%) 8 (44%) 0 (0%) 5 (63%) 3 (60%) 16 (94%) (36%) 12 (63%) 9 (47%) 0 (NA%) (50%) 0 (0%) 9 (82%) 2 (40%) 7 2 (25%) Royal College of Physicians 11 41

42 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) University Hospital of North Tees (83%) 10 (56%) 4 (50%) Arrowe Park Hospital 14 (93%) 11 (85%) 6 (46%) North West SHA Blackpool Victoria Hospital 4 3 (75%) 8 (53%) 0 (0%) 2 (40%) 0 (0%) Countess of Chester Hospital 15 (79%) 13 (87%) 4 (50%) Cumberland Infirmary (78%) 10 (71%) 5 (71%) 1 (%) East Lancashire Hospitals Trust (Royal Blackburn Hospital and Burnley District General Hospital Combined) 14 (82%) 7 (47%) 7 (70%) 4 (57%) 10 (91%) 15 (75%) (75%) 5 (50%) 14 (93%) 7 11 (92%) 2 (17%) 0 (0%) 9 (53%) 9 14 (93%) 8 (53%) 0 (0%) 0 (0%) 1 (11%) 12 (80%) 4 (27%) 2 (33%) (84%) 12 (63%) 9 (60%) 1 (50%) 3 (38%) 6 (60%) 2 (14%) 3 (21%) 12 (60%) 0 (0%) 6 (46%) 4 (29%) 4 (27%) 2 (13%) Fairfield General Hospital (0%) 1 0 (NA%) 2 (50%) 0 (0%) 0 (0%) 2 1 (50%) 1 (50%) 0 (0%) Furness General Hospital (42%) 7 (64%) 6 (86%) 3 (75%) 7 (58%) 7 (58%) 0 (0%) 1 (11%) 2 (17%) 6 (55%) 6 (55%) Lancashire Teaching Hospital NHS Foundation Trust (Chorley District General Hospital & Royal Preston Hospital Combined) 13 (76%) (71%) 5 (71%) 1 (17%) 12 (86%) 12 (92%) 16 (94%) 7 (41%) Royal College of Physicians 11 42

43 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Macclesfield District General Hospital (75%) 5 (83%) 3 9 Manchester Royal Infirmary (94%) 2 (50%) 5 (63%) 9 (82%) North Manchester General Hospital 4 17 (85%) 1 (50%) (75%) 2 (50%) 6 6 (67%) 9 (82%) 7 (41%) 10 (59%) (83%) 2 (29%) 2 (67%) 0 (0%) 5 (83%) 5 (56%) 0 (0%) 3 (75%) 1 (25%) 6 (86%) 2 (29%) Royal Albert Edward Infirmary 13 (93%) 12 (75%) 9 1 (25%) Royal Bolton Hospital (86%) 4 (50%) Royal Liverpool University Hospital (75%) 7 15 (75%) 3 3 (60%) 12 (92%) 7 (50%) 11 (69%) 3 (%) 3 (33%) 11 (69%) 8 (62%) (65%) (67%) Royal Oldham Hospital (94%) 9 (60%) 8 (73%) 4 (44%) 8 (44%) 8 (50%) 0 (0%) 1 (7%) 0 (0%) 14 (93%) 2 (13%) Salford Royal Hospital 15 (94%) 14 7 (39%) Southport & Formby District General Hospital 7 (37%) 4 (24%) 13 (87%) 5 (50%) 15 (75%) Stepping Hill Hospital (80%) 17 (85%) 8 (89%) 3 (21%) 8 (53%) 17 (85%) 14 (70%) (92%) 14 (74%) 0 (0%) 12 (75%) 3 (60%) 14 (82%) 8 (47%) 4 (40%) 7 8 (53%) 4 (%) Royal College of Physicians 11 43

44 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Tameside General Hospital 8 5 (63%) 11 (69%) 3 (50%) 0 (0%) 6 (75%) University Hospital, Aintree 15 (83%) 9 (64%) 7 (78%) 4 (80%) University Hospitals of Morecombe Bay NHS Trust (Royal Lancaster Infirmary & Westmorland General Hospital Combined) Warrington District General Hospital (69%) 1 (50%) 2 8 (80%) 17 (85%) 13 (68%) 6 (43%) 3 (33%) West Cumberland Hospital (NA%) Whiston Hospital 15 (83%) 14 (78%) 8 (57%) 5 (83%) Wythenshawe Hospital 11 (85%) 16 3 (50%) Horton General Hospital NA 1 (50%) NA John Radcliffe Hospital (50%) 17 (85%) 12 (80%) South Central SHA 2 10 (71%) 1 (50%) 0 (0%) 2 (25%) 4 (25%) 3 (%) 0 (0%) 17 (94%) 4 (57%) 12 (86%) 13 (93%) 0 (0%) 6 (75%) 4 (44%) 8 (62%) 3 (23%) 2 (22%) 12 (75%) 5 (63%) 9 (47%) 9 2 (67%) 11 (92%) 7 6 (75%) 6 (75%) 1 (13%) 15 (83%) 11 (79%) 16 (89%) 9 (50%) 7 16 (84%) 12 (92%) 10 (77%) 9 (69%) NA 1 1 (50%) NA NA NA 16 (80%) 3 (60%) 0 (0%) 1 (13%) 5 (63%) 1 (13%) Royal College of Physicians 11 44

45 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Milton Keynes Hospital 15 (79%) 13 (65%) 11 (79%) 9 (69%) North Hampshire Hospital (89%) 5 (56%) Queen Alexandra Hospital 21 8 (62%) 2 (17%) Royal Berkshire Hospital 14 (93%) 12 (86%) 8 (67%) 6 (75%) Royal Hampshire County Hospital 16 (94%) 11 (85%) 7 Southampton University Hospitals NHS Trust (Southampton General Hospital & Royal South Hants Hospital Combined) 11 (85%) 15 (79%) 3 (38%) 3 (30%) St Mary's Hospital (50%) 1 0 (NA%) Stoke Mandeville Hospital (93%) 10 (91%) 13 (93%) 3 (75%) 13 (93%) 17 (89%) 1 12 (75%) 16 (86%) 17 (85%) 16 (80%) 1 (33%) 3 (17%) 3 (17%) 10 (50%) 1 (25%) 8 7 (78%) 2 (%) 3 (30%) 5 (56%) 5 (31%) 3 (27%) 17 (81%) 5 (24%) 2 (40%) 2 (%) 0 (0%) 8 (57%) 1 (7%) 4 (57%) 10 (50%) 7 (47%) 13 (76%) 4 (24%) 3 (50%) 5 (42%) 2 (40%) 15 (79%) 4 (21%) 2 (50%) 0 (NA%) 0 (0%) 0 (0%) (73%) 2 (50%) 3 (33%) 2 (22%) 6 (55%) 3 (27%) Wycombe Hospital (33%) 6 (86%) 11 (92%) 2 2 (67%) 1 (17%) 4 (80%) 1 (%) Royal College of Physicians 11 45

46 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Brighton and Sussex University Hospitals NHS Trust (Royal Sussex County & Princess Royal Hospitals Combined) 15 (83%) 12 (86%) 8 (73%) Conquest Hospital (93%) 9 7 (54%) Darent Valley Hospital (92%) 9 (75%) 8 (73%) 2 (33%) South East Coast SHA East Surrey Hospital (63%) 5 Eastbourne District General Hospital 17 (89%) (80%) 12 (80%) (92%) 1 (10%) 9 (60%) 10 (67%) 9 (50%) 7 (39%) 6 (75%) 2 (33%) 1 (11%) 13 (87%) 9 (60%) 2 (50%) 13 (76%) 3 (25%) 5 (42%) 3 (25%) 10 (67%) 7 (70%) 3 (75%) 8 5 (63%) (89%) 7 (58%) 11 (79%) 4 5 (24%) 2 (17%) 3 (30%) 9 (60%) 5 (63%) 11 (92%) 5 (42%) Frimley Park Hospital 17 (94%) 10 (83%) 12 (92%) 3 (60%) Kent & Canterbury Hospital (75%) 0 (NA%) Maidstone Hospital (86%) 9 (82%) Medway Maritime Hospital 15 (83%) 14 (70%) 4 (31%) 2 (29%) 8 8 (73%) 12 (92%) 6 (75%) 10 (83%) 5 (42%) 3 (75%) 0 (0%) 1 (13%) 0 (0%) 1 (50%) 0 (0%) 13 (93%) 17 (85%) 4 (44%) 1 (9%) 0 (0%) 11 (79%) 3 (21%) 1 (33%) 2 (12%) 4 (29%) 7 (35%) 7 (35%) Royal College of Physicians 11 46

47 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Royal Surrey County Hospital 12 (80%) 12 (80%) 11 (92%) 4 (50%) St Richard's Hospital 11 (79%) 11 (73%) 9 4 (67%) The Tunbridge Wells Hospital (84%) 14 (78%) 13 (81%) 2 (%) Western Sussex Hospital Trust (Worthing and Southlands combined) 12 (67%) 13 (76%) 9 (69%) 6 (86%) William Harvey Hospital 16 (89%) 12 (63%) 13 (81%) 5 (71%) 14 (70%) 16 (80%) 16 (76%) 15 (75%) South West SHA Bristol Royal Infirmary 16 (94%) 9 (53%) 7 4 Derriford Hospital (94%) 9 9 (56%) 5 (71%) Dorset County Hospital (86%) 3 (43%) Gloucestershire Hospitals NHS Foundation Trust (Gloucestershire Royal and Cheltenham General Combined) (71%) 2 2 (29%) 17 (85%) 15 (94%) 13 (76%) 7 16 (80%) 14 (70%) 14 (70%) (79%) 2 (17%) 6 (75%) 5 (71%) 11 (73%) 5 (33%) 1 (13%) 7 (58%) 7 (78%) 14 (93%) 4 (27%) 0 (0%) 7 (78%) 1 (25%) 6 (33%) 8 (44%) 0 (0%) 8 (62%) 11 (79%) 16 (94%) 6 (35%) 2 (50%) 11 (69%) 5 (50%) 11 (58%) 4 (21%) 3 (27%) 10 (77%) 6 (75%) 16 (94%) 4 (24%) 6 (86%) 16 2 (67%) 7 (78%) 3 (33%) 5 (83%) 4 (33%) 3 (25%) 14 (93%) 9 (60%) 2 (67%) 1 (25%) 3 (30%) 4 (24%) 6 (35%) Royal College of Physicians 11 47

48 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Great Western Hospital 12 (80%) 10 (63%) 8 (57%) 2 (25%) Musgrove Park Hospital (89%) 5 (83%) 7 (50%) North Bristol NHS Trust (Frenchay and Southmead Hospitals Combined) 12 7 (70%) 10 (71%) 5 (50%) 5 (42%) 16 (80%) (86%) 12 North Devon District Hospital (83%) 11 4 (80%) 3 (50%) 5 (83%) Poole General Hospital (94%) 9 14 Royal Bournemouth Hospital 11 (79%) 12 (86%) 8 (73%) Royal Cornwall Hospital 16 (94%) 14 (74%) 7 2 (25%) Royal Devon & Exeter Hospital (92%) 6 (75%) Salisbury District General Hospital (91%) 3 (50%) 0 (0%) Torbay Hospital 12 (80%) 17 3 (75%) 10 (77%) 12 (92%) 17 (85%) 17 (94%) (77%) 13 1 (33%) 12 (75%) 9 (82%) 13 (81%) 4 (25%) 2 (29%) 8 (57%) 11 (79%) 12 (67%) 6 (33%) 1 (25%) 8 (89%) 11 (79%) 10 (71%) 7 (50%) 0 (0%) 2 (40%) 8 (80%) 10 (91%) 2 (%) 0 (NA%) 1 (11%) 0 (0%) 16 (94%) 10 (59%) 7 (64%) 5 (33%) 5 (63%) 8 (57%) 2 (14%) 4 (40%) 7 (54%) 8 (89%) 12 (63%) 5 (26%) 1 (11%) 7 (58%) 3 (33%) 13 (87%) 7 (47%) 1 (33%) 5 (71%) 4 (57%) 3 (27%) 2 (%) 5 (63%) 11 (79%) 3 (43%) 7 (47%) 6 (40%) Royal College of Physicians 11 48

49 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Weston General Hospital (67%) 10 4 (57%) Yeovil District Hospital 13 (93%) 17 (85%) 10 (83%) 5 (50%) George Eliot Hospital 15 8 (73%) 15 (79%) 3 (60%) 5 (56%) Good Hope Hospital (93%) 9 10 (77%) 3 (75%) Heart of England NHS Foundation Trust (Birmingham Heartlands Hospital and Solihull Hospital) (82%) 9 (75%) 5 (50%) 12 West Midlands SHA 13 (87%) 10 (71%) 14 (93%) 15 (75%) 16 (80%) 2 (67%) 8 (73%) 5 (42%) 10 (83%) 3 (25%) 2 (%) 5 (38%) 2 (14%) 12 (60%) 1 (13%) 5 (63%) 8 (53%) 10 (53%) 8 (42%) 7 (54%) 3 9 (69%) 3 (33%) 7 (70%) 9 7 (78%) 10 (83%) 5 (71%) (71%) Hereford County Hospital (78%) 6 (60%) 5 (83%) 3 (60%) 9 8 (80%) 0 (0%) 6 (75%) 4 (67%) 8 (80%) 3 (30%) Mid Staffordshire NHS Foundation Trust (Staffordshire General Hospital & Cannock Chase Hospital Combined) 17 9 (75%) 8 (89%) 9 3 (60%) 15 (79%) 15 0 (0%) 5 (50%) 6 (67%) 8 (89%) 1 (11%) New Cross Hospital 15 (94%) 8 (73%) 8 (53%) 2 (40%) 0 (0%) 9 (56%) 5 (63%) 9 (82%) 4 (36%) Queen's Hospital, Burton (83%) 9 (82%) 4 (67%) 0 (0%) 11 (92%) 12 (80%) 3 (50%) 6 (55%) 1 (13%) 11 5 (45%) Royal College of Physicians 11 49

50 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Russells Hall Hospital 15 (94%) 10 (71%) 5 (45%) Sandwell and West Birmingham Hospitals NHS Trust (City Hospital and Sandwell Hospital Combined) Shrewsbury & Telford Hospital NHS Trust (Royal Shrewsbury Hospital & Princess Royal Hospital, Telford Combined) University Hospital Birmingham NHS Foundation Trust (Queen Elizabeth Hospital, Birmingham & Selly Oak Hospital Combined) University Hospital of North Staffordshire University Hospitals Coventry & Warwickshire NHS Trust 16 (89%) 10 (71%) 17 (94%) 4 (80%) 15 (94%) 13 6 (67%) (91%) 3 (75%) 2 (67%) 16 (94%) 12 (63%) 16 7 (70%) 15 (94%) 11 (69%) 6 (55%) 1 (13%) Walsall Manor Hospital (75%) 9 5 (56%) Warwick Hospital 8 4 (80%) 9 3 (60%) 2 (40%) Worcestershire Acute Hospitals NHS Trust (Worcestershire Royal Hosp & Alexandra Hosp Combined) 12 (80%) 9 (75%) 4 (44%) 16 (80%) (85%) (92%) 16 (89%) 17 (85%) 7 14 (78%) 11 (73%) 16 7 (44%) 3 15 (83%) 4 (36%) 9 (64%) 3 (21%) 1 (33%) 10 (63%) 10 (71%) 13 (81%) 9 (56%) 2 (50%) (82%) 0 (0%) 10 (83%) 9 (69%) 17 (89%) 11 (58%) 7 9 (64%) 6 (75%) 11 (69%) 3 (%) 0 (0%) 6 (67%) 8 (89%) 10 (63%) 6 (38%) 0 (0%) 2 (40%) 2 (33%) 8 (80%) 4 (40%) 5 (83%) 16 (80%) 8 (62%) 8 (53%) 7 (47%) Royal College of Physicians 11 50

51 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Airedale General Hospital (33%) Barnsley District General Hospital (85%) 7 (41%) 9 (82%) 5 (71%) Bradford Royal Infirmary (86%) 10 (77%) 2 (33%) Calderdale & Huddersfield NHS Foundation Trust (Huddersfield Royal Infirmary and Calderdale Hospital Combined) (93%) 16 (94%) 9 (69%) 6 (60%) Dewsbury & District Hospital (77%) 10 (83%) 9 (82%) 6 (86%) Diana, Princess of Wales Hospital 16 (89%) 14 (78%) 9 (75%) 3 (50%) Harrogate District Hospital (50%) 3 (75%) 1 (%) Hull and East Yorkshire NHS Trust (Hull Royal Infirmary and Castle Hill Hospitals Combined) Leeds Teaching Hospitals NHS Trust (Leeds General Infirmary & St James's Hospital Combined) 11 (85%) 10 (77%) 8 (80%) 4 (57%) (78%) 7 (70%) 3 (38%) Yorkshire & The Humber SHA 10 (91%) 11 (69%) (50%) 6 16 (80%) 12 (60%) 11 (92%) 12 (63%) 1 (33%) 9 10 (71%) 3 (16%) 2 (29%) 5 (45%) 1 (14%) 4 (24%) 4 (24%) 1 (%) 11 (92%) 7 9 (64%) 3 (21%) 3 (38%) 12 (92%) 0 (0%) (65%) 6 (35%) 5 (63%) 11 (92%) 6 (50%) 2 (22%) 6 (46%) 5 (63%) 5 (28%) 3 (17%) 6 (86%) (60%) 2 (33%) 2 (33%) 2 (50%) 9 9 (82%) 9 (69%) 7 (54%) 3 (38%) 10 (91%) 10 (91%) 12 (67%) 6 (33%) Royal College of Physicians 11 51

52 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Pinderfields General Hospital (93%) 10 4 (57%) Rotherham Hospital 10 (83%) 7 (70%) 6 (86%) 4 (80%) Scarborough General Hospital (86%) 5 8 (67%) 4 (80%) 13 (81%) Scunthorpe General Hospital (40%) 9 (56%) 6 (86%) 3 (33%) 7 (58%) Sheffield Teaching Hospitals NHS Foundation Trust (Royal Hallamshire Hospital & Northern General Hospital Combined) 14 (78%) 14 (78%) 11 (79%) 4 (44%) York Hospital 13 (93%) 10 (91%) 11 (92%) (71%) States of Jersey Health & Social Services 2 (25%) 12 5 (83%) 11 (79%) 4 (29%) 0 (0%) 6 (60%) 2 (67%) 9 2 (%) 2 (33%) (80%) 3 (60%) 0 (0%) 3 (50%) 1 (14%) 13 (81%) 4 (25%) 4 (57%) 15 (94%) 11 (92%) 10 (56%) 6 (33%) 5 (71%) (45%) Jersey General Hospital (71%) 5 (45%) 2 (50%) 1 (13%) 4 (57%) 3 (27%) 1 (17%) 1 (%) 0 (0%) 7 (64%) 2 (%) Belfast Health and Social Care Trust Belfast City Hospital (43%) 4 1 (25%) 7 Mater Hospital (50%) (67%) 3 (43%) 3 (60%) 4 (57%) 2 (29%) 0 (0%) 4 (80%) 1 (50%) 1 (50%) 1 (50%) Royal College of Physicians 11 52

53 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Royal Victoria Hospital 11 (79%) 11 (61%) 9 (82%) 4 (50%) Antrim Area Hospital 12 (63%) 13 (68%) 11 (73%) 4 (44%) Causeway Hospital (75%) Northern Health and Social Care Trust 16 (80%) (80%) South Eastern Health and Social Care Trust 5 (56%) 9 (75%) 10 (83%) 7 (39%) 5 (28%) 0 (0%) 11 (65%) 9 (75%) 4 (21%) 4 (21%) 6 (86%) 1 (50%) 7 (78%) 6 5 (71%) 2 (29%) Lagan Valley Hospital (75%) 1 0 (0%) 1 (50%) 2 (50%) 0 (0%) 0 (0%) 0 (0%) 1 (25%) 1 (25%) Ulster Hospital 11 (61%) 9 (56%) 5 (38%) 1 (%) Craigavon Area Hospital 17 5 (33%) 6 (33%) 8 (89%) 2 (50%) Daisy Hill Hospital (86%) 12 (67%) 9 (82%) 4 (36%) 17 (85%) 16 (84%) Southern Health and Social Care Trust 16 (94%) 13 (87%) 17 (85%) Western Health and Social Care Trust 3 (%) 10 (91%) 8 (89%) 11 (69%) 7 (44%) 2 (67%) 10 (67%) 8 (73%) 14 (78%) 7 (39%) 5 (42%) 0 (0%) 5 (83%) 15 (83%) 5 (28%) Altnagelvin Area Hospital 12 7 (70%) 9 (64%) 5 (83%) (29%) 6 (75%) 7 (78%) 8 (57%) 4 (29%) Royal College of Physicians 11 53

54 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) NHS Ayrshire & Arran Crosshouse Hospital (60%) 6 (43%) 6 (67%) 2 (50%) 9 (53%) NHS Borders Borders General Hospital (94%) 5 (83%) 6 (60%) 9 (82%) Dumfries & Galloway Royal Infirmary (92%) 7 (78%) 9 5 (63%) NHS Dumfries & Galloway 11 (85%) NHS Forth Valley Stirling Royal Infirmary (80%) 1 (50%) 4 (57%) Aberdeen Royal Infirmary 16 (94%) 12 (67%) 7 (70%) NHS Grampian 11 (65%) 10 (63%) 0 (0%) 1 (7%) 2 (22%) 12 (86%) 4 (29%) 0 (0%) 0 (0%) 2 (33%) 15 (94%) 13 (81%) 5 (56%) 0 (0%) 7 (58%) 4 (50%) 7 (78%) 5 (56%) 15 NHS Greater Glasgow & Clyde Glasgow Royal Infirmary 7 7 (78%) 5 4 NHS Lanarkshire Hairmyres Hospital (60%) 4 (57%) 1 (33%) 0 (NA%) 3 (50%) 8 0 (0%) 0 (0%) 1 (14%) 8 (73%) 3 (27%) 0 (0%) 0 (0%) 2 (%) 17 5 (29%) 0 (0%) 3 (43%) 1 (17%) 6 (67%) 5 (56%) 0 (0%) 0 (0%) 1 (25%) 6 (86%) 3 (43%) Royal College of Physicians 11 54

55 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Monklands Hospital (67%) 3 2 Wishaw General Hospital (50%) 10 (77%) 0 (NA%) 4 (50%) Western General Hospital 11 (85%) 13 (87%) 6 (86%) Ninewells Hospital (68%) 6 (60%) 3 4 NHS Lothian NHS Tayside 5 (71%) 0 (0%) 1 (50%) 2 (33%) 3 (50%) 3 (50%) Abertawe Bro Morgannwg University Health Board Morriston Hospital (80%) 4 (50%) 4 (50%) 2 11 (79%) Neath Port Talbot Hospital (86%) (86%) (0%) 0 (0%) 9 (82%) 12 (92%) 3 (23%) 3 (33%) 16 5 (83%) 11 (85%) 3 (23%) 1 (25%) 10 (50%) 16 (84%) 13 (62%) 0 (0%) 6 (86%) 6 3 (38%) 0 (0%) 0 (0%) (75%) 2 (50%) Princess of Wales Hospital (63%) 5 2 (50%) 4 (80%) 9 (82%) (67%) 6 (75%) 2 (25%) Caerphilly District Miner's Hospital (50%) 1 0 (NA%) 0 (0%) Aneurin Bevan Health Board (NA%) 0 (0%) (0%) Royal College of Physicians 11 55

56 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Nevill Hall Hospital 15 7 (70%) 9 (50%) 3 2 (33%) Royal Gwent Hospital (89%) 3 (60%) 13 (87%) (70%) 16 (89%) Betsi Cadwaladr University Health Board 0 (0%) 5 (63%) 7 (64%) 5 (28%) 4 (22%) 0 (0%) 10 (91%) 13 (93%) 1 (6%) 9 (53%) Glan Clwyd Hospital (71%) 1 (33%) 2 5 (83%) 8 (80%) 1 1 (33%) 1 (25%) 5 (71%) 3 (43%) Wrexham Maelor Hospital (80%) 7 (58%) 11 (85%) 2 (50%) 15 (94%) 1 (25%) 9 (82%) 8 11 (92%) 4 (33%) Ysbyty Gwynedd (80%) 4 (67%) 3 0 (NA%) 7 5 (83%) 0 (NA%) 3 (60%) 0 (0%) 2 (33%) 2 (33%) University Hospital Llandough (80%) 1 (50%) University Hospital of Wales 14 (70%) 11 (69%) 12 (92%) 2 (22%) Prince Charles Hospital (58%) 4 (80%) 4 (50%) Royal Glamorgan Hospital (69%) 6 (86%) 7 (78%) Cardiff & Vale University Health Board 11 (92%) 17 (85%) Cwm Taf Health Board 10 (71%) 11 (73%) 6 (75%) (0%) 11 (69%) 11 (69%) 4 (31%) 11 (79%) 6 (55%) 12 (75%) 7 (44%) 0 (0%) 5 (71%) 8 (80%) 10 (83%) 6 (50%) 2 (67%) 7 7 (64%) 7 (54%) 4 (31%) Royal College of Physicians 11 56

57 Key Indicators How many cases were entered to the UK IBD audit? by a consultant gastroenterologist during their (this does not apply to patients who were admitted for either elective surgery or who were under the direct care of a surgeon) In patients with diarrhoea, was a stool sample sent for Standard Stool Culture (SSC)? (SSC is a test to identify bacteria or viruses that may be causing an infection) Was prophylactic Heparin prescribed? (This medication is used to prevent and treat blood clots) prescribed rescue therapy during the (Drugs that decrease the action of the body s immune system) If the patient was prescribed steroids on discharge, were they also prescribed bone protection agents? weighed during (Crohn s disease only) by a dietician during their (Crohn s disease only) UK results 10 = = (78%) 1537 (79%) 726 (55%) (87%) 397 (38.7%) 1443 (66%) 1022 (58%) 46 (72%) 980 (38%) Hywel Dda Health Board Bronglais General Hospital (57%) 3 1 (50%) 3 (60%) 8 (89%) 0 (NA%) 1 (%) 1 5 (71%) 4 (57%) Withybush General Hospital (67%) 4 1 (33%) 8 (67%) 6 (60%) 1 (%) 4 (67%) 1 (33%) 5 (56%) 2 (22%) Royal College of Physicians 11 57

58 Appendices Appendix 1: Glossary / Abbreviations Abbreviation Full title 5ASA 5 Aminosalicyclic acid ACPGBI Association of Coloproctology of Great Britain and Ireland Anti TNF Anti Tumour Necrosis Factor Alpha ASA Status American Society of Anesthesiologists Status BPM Beat Per Minute BSG British Society for Gastroenterology BSPGHAN British Society for Paediatric Gastroenterology Hepatology and Nutrition CD Crohn's Disease CDT Clostridium Difficile Toxin CEEu Clinical Effectiveness and Evaluation Unit CQC Care Quality Commission CRP C Reactive Protein o C Degrees Celsius F2 Foundation Doctor Year 2 HQIP Health Quality Improvement Partnership IBD Inflammatory Bowel Disease IBDQIP Inflammatory Bowel Disease Quality Improvement Project IQR Inter Quartile Range MG/DAY Milligrams per Day NCAPOP National Clinical Audit and Patient Outcomes Programme NICE National Institute for Health and Clinical Excellence NSF National Service Framework RCN Royal College of Nursing RCP Royal College of Physicians SG Steering Group SHO Senior House Officer SSC Standard Stool Culture UC Ulcerative Colitis UK United Kingdom Royal College of Physicians 11 58

59 Appendix 2: Members of the UK IBD Audit Steering Group Chair Dr Ian Arnott, consultant gastroenterologist, Western General Hospital, Edinburgh Association of Coloproctology of Great Britain and Ireland Mr Bruce George, consultant colorectal surgeon, John Radcliffe Hospital Association of Coloproctology of Great Britain and Ireland Mr Graeme Wilson, consultant colorectal surgeon, Western General Hospital, Edinburgh British Dietetic Association Ms Miranda Lomer, consultant dietician, Guy's and St Thomas' NHS Foundation Trust British Society of Gastroenterology Dr Stuart Bloom, consultant gastroenterologist, University College Hospital British Society of Gastroenterology Dr Keith Bodger, consultant physician & gastroenterologist, University Hospital Aintree British Society of Gastroenterology Dr Barney Hawthorne, consultant gastroenterologist, University Hospital of Wales British Society of Gastroenterology Dr Keith Leiper, consultant gastroenterologist, Royal Liverpool University Hospital British Society of Gastroenterology Professor Chris Probert, consultant gastroenterologist, Bristol Royal Infirmary British Society of Gastroenterology Professor Jonathan Rhodes, professor of medicine, University of Liverpool British Society of Gastroenterology Mrs Chris Romaya, executive secretary British Society of Gastroenterology Dr Ian Shaw, consultant gastroenterologist, Gloucestershire Royal Hospital British Society of Gastroenterology Dr Abraham Varghese, consultant gastroenterologist, Causeway Hospital British Society of Paediatric Gastroenterology, Hepatology and Nutrition Dr Sally Mitton, consultant paediatric gastroenterologist, St George s Hospital British Society of Paediatric Gastroenterology, Hepatology and Nutrition Dr Richard Russell, consultant paediatric gastroenterologist, Yorkhill Hospital, Glasgow Health Services Modernisation Mr. John Frankish, Aneurin Bevan Health Board Crohn s and Colitis UK (NACC) Mr Richard Driscoll, chief executive Crohn s and Colitis UK (NACC) Ms Elaine Steven, vice president Primary Care Society for Gastroenterology Dr John O Malley, clinical director, All Day Health Centre, Arrowe Park Hospital Royal College of Nursing Crohn's and Colitis Special Interest Group Ms Karen Kemp, IBD clinical nurse specialist, Manchester Royal Infirmary Royal College of Nursing Crohn's and Colitis Special Interest Group Ms Allison Nightingale, IBD clinical nurse specialist, Addenbrooke s Hospital Royal College of Physicians Ms Rhona Buckingham, manager, Clinical Effectiveness and Evaluation Unit Royal College of Physicians Mr Calvin Down, project manager, UK IBD audit Royal College of Physicians Ms Jane Ingham, director of Clinical Standards Royal College of Physicians Miss Aimee Protheroe, project coordinator, UK IBD audit Royal College of Physicians Dr Jonathan Potter, clinical director, Clinical Effectiveness and Evaluation Unit Royal College of Physicians Dr Kevin Stuart, clinical director, Clinical Effectiveness and Evaluation Unit Royal College of Physicians 11 59

60 Royal College of Physicians Professor John Williams, consultant gastroenterologist, Abertawe Bro Morgannwg University NHS Trust & Director of Health Informatics Unit, RCP Royal Pharmaceutical Society of Great Britain Ms Anja St. Clair Jones, lead pharmacist surgery and digestive diseases, Royal Sussex County Hospital Royal College of Physicians 11 60

61 Appendix 3: Audit Participants Each of the sites listed below contributed to the 10 round of the adult audit, submitting one or more cases for inclusion: Aberdeen Royal Infirmary Addenbrooke's Hospital Airedale General Hospital Altnagelvin Area Hospital Antrim Area Hospital Arrowe Park Hospital Barnet General Hospital Barnsley District General Hospital Basildon Hospital Bedford Hospital Belfast City Hospital Blackpool Victoria Hospital Borders General Hospital Bradford Royal Infirmary Brighton and Sussex University Hospitals NHS Trust (Royal Sussex County & Princess Royal Hospitals Combined) Bristol Royal Infirmary Bronglais General Hospital Broomfield Hospital Caerphilly District Miner's Hospital Calderdale & Huddersfield NHS Foundation Trust (Huddersfield Royal Infirmary and Calderdale Hospital Combined) Causeway Hospital Central Middlesex Hospital Chelsea & Westminster Hospital Chesterfield Royal Hospital Colchester General Hospital Conquest Hospital Countess of Chester Hospital County Durham & Darlington NHS Foundation Trust (Darlington Memorial Hospital and Bishop Auckland Hospital Combined) Craigavon Area Hospital Crosshouse Hospital Cumberland Infirmary Daisy Hill Hospital Darent Valley Hospital Derriford Hospital Dewsbury & District Hospital Diana, Princess of Wales Hospital Dorset County Hospital Dumfries & Galloway Royal Infirmary Ealing Hospital East and North Hertfordshire NHS Trust (Lister Hospital & Queen Elizabeth II Hospital Combined) East Lancashire Hospitals Trust (Royal Blackburn Hospital and Burnley District General Hospital Combined) East Surrey Hospital Eastbourne District General Hospital Royal College of Physicians 11 61

62 Epsom General Hospital Fairfield General Hospital Freeman Hospital Friarage Hospital Frimley Park Hospital Furness General Hospital George Eliot Hospital Glan Clwyd Hospital Glasgow Royal Infirmary Gloucestershire Hospitals NHS Foundation Trust (Gloucestershire Royal and Cheltenham General Combined) Good Hope Hospital Great Western Hospital Guy's & St Thomas' NHS Foundation Trust (Guy's & St Thomas' Hospitals Combined) Hairmyres Hospital Harrogate District Hospital Heart of England NHS Foundation Trust (Birmingham Heartlands Hospital and Solihull Hospital) Hereford County Hospital Hillingdon Hospital Hinchingbrooke Hospital Homerton University Hospital Horton General Hospital Hull and East Yorkshire NHS Trust (Hull Royal Infirmary and Castle Hill Hospitals Combined) Imperial College Healthcare NHS Trust (Charing Cross, Hammersmith and St Mary's Hospitals Combined) Ipswich Hospital James Cook University Hospital James Paget Hospital Jersey General Hospital John Radcliffe Hospital Kent & Canterbury Hospital Kettering General Hospital King George Hospital King's College Hospital Kingston Hospital Lagan Valley Hospital Lancashire Teaching Hospital NHS Foundation Trust (Chorley District General Hospital & Royal Preston Hospital Combined) Leeds Teaching Hospitals NHS Trust (Leeds General Infirmary & St James's Hospital Combined) Lincoln County Hospital Luton & Dunstable Hospital Macclesfield District General Hospital Maidstone Hospital Manchester Royal Infirmary Mater Hospital Mayday Hospital Medway Maritime Hospital Mid Staffordshire NHS Foundation Trust (Staffordshire General Hospital & Cannock Chase Hospital Combined) Milton Keynes Hospital Royal College of Physicians 11 62

63 Monklands Hospital Morriston Hospital Musgrove Park Hospital Neath Port Talbot Hospital Nevill Hall Hospital New Cross Hospital Newham University Hospital Ninewells Hospital Norfolk & Norwich University Hospital North Bristol NHS Trust (Frenchay and Southmead Hospitals Combined) North Devon District Hospital North Hampshire Hospital North Manchester General Hospital North Middlesex University Hospital North Tyneside General Hospital North West London Hospitals NHS Trust (St Mark's & Northwick Park Hospitals Combined) Northampton General Hospital Nottingham University Hospital NHS trust (Queen's Medical Centre & Nottingham City Hospital Combined) Peterborough City Hospital (prev Peterborough district hosp until Nov 10) Pilgrim Hospital Pinderfields General Hospital Poole General Hospital Prince Charles Hospital Princess Alexandra Hospital, Harlow Princess of Wales Hospital Queen Alexandra Hospital Queen Elizabeth Hospital Queen Elizabeth Hospital, Gateshead Queen Elizabeth Hospital, Woolwich Queens Hospital Queen's Hospital, Burton Rotherham Hospital Royal Albert Edward Infirmary Royal Berkshire Hospital Royal Bolton Hospital Royal Bournemouth Hospital Royal Cornwall Hospital Royal Derby Hospital Royal Devon & Exeter Hospital Royal Free Hospital Royal Glamorgan Hospital Royal Gwent Hospital Royal Hampshire County Hospital Royal Liverpool University Hospital Royal London Hospital Royal Oldham Hospital Royal Surrey County Hospital Royal Victoria Hospital Royal Victoria Infirmary, Newcastle Russells Hall Hospital Royal College of Physicians 11 63

64 Salford Royal Hospital Salisbury District General Hospital Sandwell and West Birmingham Hospitals NHS Trust (City Hospital and Sandwell Hospital Combined) Scarborough General Hospital Scunthorpe General Hospital Sheffield Teaching Hospitals NHS Foundation Trust (Royal Hallamshire Hospital & Northern General Hospital Combined) Sherwood Forest Hospitals NHS Foundation Trust (King's Mill Hospital & Newark Hospital Combined) Shrewsbury & Telford Hospital NHS Trust (Royal Shrewsbury Hospital & Princess Royal Hospital, Telford Combined) South Tyneside District Hospital Southampton University Hospitals NHS Trust (Southampton General Hospital & Royal South Hants Hospital Combined) Southport & Formby District General Hospital St George's Hospital St Helier Hospital St Mary's Hospital St Richard's Hospital Stepping Hill Hospital Stirling Royal Infirmary Stoke Mandeville Hospital Sunderland Royal Hospital Tameside General Hospital The Lewisham Hospital The Tunbridge Wells Hospital Torbay Hospital Ulster Hospital University College Hospital University Hospital Birmingham NHS Foundation Trust (Queen Elizabeth Hospital, Birmingham & Selly Oak Hospital Combined) University Hospital Llandough University Hospital of Hartlepool University Hospital of North Durham University Hospital of North Staffordshire University Hospital of North Tees University Hospital of Wales University Hospital, Aintree University Hospitals Coventry & Warwickshire NHS Trust University Hospitals of Leicester NHS Trust (Leicester Royal Infirmary and Leicester General Combined) University Hospitals of Morecombe Bay NHS Trust (Royal Lancaster Infirmary & Westmorland General Hospital Combined) Walsall Manor Hospital Warrington District General Hospital Warwick Hospital West Cumberland Hospital West Hertfordshire Hospitals NHS Trust (Watford General Hospital & Hemel Hempstead General Hospital Combined) West Middlesex Hospital West Suffolk Hospital Western General Hospital Western Sussex Hospital Trust Royal College of Physicians 11 64

65 (Worthing and Southlands combined) Weston General Hospital Whipps Cross University Hospital Whiston Hospital Whittington Hospital William Harvey Hospital Wishaw General Hospital Withybush General Hospital Worcestershire Acute Hospitals NHS Trust (Worcestershire Royal Hospital & Alexandra Hospital Combined) Wrexham Maelor Hospital Wycombe Hospital Wythenshawe Hospital Yeovil District Hospital York Hospital Ysbyty Gwynedd Royal College of Physicians 11 65

66 Appendix 4: Action Plan This action plan has been produced to enable you to take forward the recommendations of this national audit and allows for localisation in the addition of further actions as you feel appropriate for your own service. We would recommend the use of the IBDQIP Shared Document Store (SDS) as a particularly useful resource when considering the actions required below, here you can freely access guidelines, business cases and examples of best practice from around the UK. National recommendation Action required Staff responsible Progress at your site 1. Sites should aim to continue to a) Submission of all relevant local cases UK IBD Audit Clinical Lead deliver high quality care for to the UK IBD Audit b) All IBD patients with diarrhoea should Consultant Gastroenterologists patients with UC and CD, be considered for stool sample including collecting stool collection for SSC and CDT specimens and giving prophylactic c) All IBD inpatients should be Consultant Gastroenterologists Heparin to all appropriate prescribed Heparin, unless inpatients contraindicated 2. Sites should consider the value of rescue therapy for patients that do not respond to intravenous steroids 3. Bone protection should be prescribed to all patients who receive corticosteroids 4. Sites should continue to ensure appropriate use of specialist wards areas 5. Further audit is needed on the use of Anti TNF drugs and sites are encouraged to participate in the ongoing UK IBD Biologics Audit 6. Sites are strongly encouraged to review the therapy received by d) In patients with no/poor response to steroid treatment, Ciclosporin / Anti TNF should be considered e) Local policy should dictate that bone protection agents are prescribed to all IBD patients started on steroid treatment f) All IBD patients should be admitted directly to specialist gastroenterology wards g) Any site providing biological treatment (Infliximab or Adalimumab) to IBD patients, should be registered to participate in the UK IBD Biologics Audit (or a relevant alternative) h) Local review of existing evidence should be undertaken to inform any Consultant Gastroenterologists Consultant Gastroenterologists / Hospital policy managers Bed Managers / Ward Staff UK IBD Audit Clinical Lead Consultant Gastroenterologists

67 all IBD patients. 5ASA drugs may be stopped in many CD cases and the use immunomodulators and biologics in keeping with national clinical guidance will help to reduce long term steroid use and the need for admission 7. Sites should continue to focus on the nutritional need of patients with CD ensuring they have appropriate dietetic support 8. Patients with CD who smoke, should be encouraged to engage with formal smoking cessation services 9. ENTER THE LOCAL ACTIONS YOU HAVE IDENTIFIED HERE continued use of 5ASA drugs in CD patients i) Any patient on long term steroids (>3 months) should be under regular review j) All CD inpatients should have their weight regularly monitored (weekly/daily?) k) Business cases should put forward to promote the need for further dietetic support for IBD inpatients l) Leaflets promoting local smoking cessation services should be handed to all CD inpatients that smoke Consultant Gastroenterologists Nursing staff / Healthcare assistants Consultant Gastroenterologists / All members of the IBD Team 10. ENTER THE LOCAL ACTIONS YOU HAVE IDENTIFIED HERE

68 Royal College of Physicians 11 St Andrews Place Regent s Park London NW1 4LE Inflammatory Bowel Disease audit team Tel: +44 (0) /1566 Fax: +44 (0) ibd.audit@rcplondon.ac.uk