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‘Every patient, every time’: Inpatient protocol standardizes ulcerative colitis care
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Since implementing its Inpatient Ulcerative Colitis Protocol in 2016, the University of California San Francisco has improved the uniform application of core management practices.
In a study published in Inflammatory Bowel Diseases, Sara M. Lewin, MD, of the division of gastroenterology at UCSF, and colleagues wrote that applying this protocol reduces variation in care while promoting evidence-based practice.
“Unfortunately, variation in patient care practices occurs commonly within the inflammatory bowel disease field and is a marker for reduced care quality,” Lewin and co-first author Ryan A. McConnell, MD, from the Palo Alto Medical Foundation, told Healio Gastroenterology and Liver Disease in an email. “The initial inpatient management of severe [UC] is amenable to a standardized care pathway, as a core set of evidence-based care items should be performed for every patient, every time.”
The UCSF Inpatient Ulcerative Colitis Protocol was built around standardized, core recommendations, as well as a daily checklist for gastroenterology consultant notes, a bundled inflammatory bowel disease electronic order set and an opiate awareness campaign.
Researchers assessed adherence to three evidence-based care metrics — Clostridium difficile testing performed, pharmacologic venous thromboembolism (VTE) prophylaxis ordered and opiates avoided — before and after the protocol was implemented on July 1, 2016. They included all adult patients hospitalized for UC between July 1, 2014 and December 31, 2017 in their study (n = 93; 36 preintervention, 57 postintervention).
While C. diff testing was performed in 100% of cases before and after the protocol was implemented, VTE prophylaxis ordering increased from 84% of hospital days before intervention to 100% after intervention (P .001).
Investigators found that administration of opioids decreased from 67% of hospitalizations before intervention to 53% postintervention (P = .18). The median daily dose of oral morphine equivalents also went down, from 12.1 mg before intervention to 0.5 mg after intervention (P = .02).
Composite adherence to all three metrics was higher after intervention (25% vs. 47%; P = .03).
Lewin and McConnell said their goal was to help clinicians, particularly those who are not experts in IBD, manage the complex care of patients with UC.
“The reduction in opiate analgesic exposure was particularly striking, including a significant reduction in discharge prescriptions for opiates,” they said in the email. “We hope that this care protocol will be a helpful tool to improve care for hospitalized ulcerative colitis patients, especially in settings lacking access to IBD specialty care.” – by Alex Young
Disclosure: Lewin and McConnell report no relevant financial disclosures.
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