Joint medical/surgical clinic review and discussion at multidisciplinary team meetings is important for optimal patient outcomes – especially for those who have recently been diagnosed with IBD, where surgery was undertaken at diagnosis or early surgical treatment is possible/necessary.
Specialist nurses play an important role in providing information, support and holistic care before and after surgery, including on the potential impact on lifestyle and approaches to long-term management.
Statement 5.1
Patients should have access to coordinated surgical and medical clinical expertise pre- and post- operatively, which should include regular combined or parallel clinics with a specialist colorectal surgeon (paediatric colorectal surgeon where appropriate), IBD gastroenterologist and clinical nurse specialist.
Statement 5.5
Prior to elective surgery, a full assessment and optimisation of medical treatment, physical condition and nutritional status should be undertaken to minimise risk of complications and aid post-operative recovery.
IBD Clinical Nurse Specialist, Michael Cervantes, led an innovative project at St. Mark’s Hospital to proactively address delays to IBD elective surgery and improve patient experience by introducing an IBD Surgical Link Nurse role.
IBD patients at St Mark's Hospital were experiencing delays to elective surgery, in breach of Statement 5.9 in the IBD Standards: "Planned surgery for IBD should be performed within 4 weeks from the decision to operate or as soon as the patient’s clinical status has been optimised."
Stakeholders including consultant colorectal surgeons, resident surgical officers, and an IBD Dietitian were all involved in meetings led by an IBD CNS to scope the problem and the potential ways to improve the situation. A new role was created for a dedicated IBD Surgical Link Nurse, to work with the colorectal surgical team. This would improve communication and surgical pathways for IBD patients awaiting surgery by offering them a single point of access to their IBD team.
Through the creation of this role, the team at St Mark's Hospital aimed to proactively identify IBD patients at risk of deterioration while on waiting lists. They wanted to ensure that IBD patients referred for surgery were prioritised according to clinical need, recognising potential delays to surgery early on and addressing them accordingly.
A bi-weekly meeting was therefore put in place to identify patients at risk of deterioration. To help stratify patients, the team used the Royal College of Surgeons (RCS) of England, RCS in Ireland, the RCS of Edinburgh, and Royal College of Physicians and Surgeons of Glasgow’s clinical guide to surgical prioritisation during the COVID-19 pandemic (April 2020):
• Priority Level 2: operation <1 month
• Priority Level 3: operation <3 months
• Priority Level 4: operation >3 months
The introduction of the IBD Surgical Link Nurse role has already resulted in positive changes to the delivery of IBD surgery and management at St. Mark’s, and has improved the experience of patients waiting for elective IBD surgery.
The team intend to use their preliminary outcomes to lobby for the formalisation of a full-time substantive IBD Surgical Nurse role within the service, with the aim of developing the role to be more involved with pre and post operative pathways, including: counselling, Enhanced Recovery After Surgery, and a nurse-led post-operative clinic for patients who have had ileo-colonic resection.
In October 2021, Crohn’s & Colitis UK surveyed more than 7,000 of their members and found that 29% of respondents had their surgery cancelled during the previous 12 months. In light of these findings, the introduction of the IBD Surgical Link Nurse role is timely and the St. Mark’s team have a vision to improve and develop it, maintaining an up-to-date register in future of IBD patients needing surgery at the point of referral, in order to monitor their clinical status, as well as to proactively recognise potential delays to surgery and address them.
This project was a Richard Driscoll Award Finalist in 2022 with Tillotts Logic IBD STARS Support, Training And Recognising Success.
Date created: December 2022
