Case Study: Education Clinics, Warrington and Halton Teaching Hospitals

Statement 4.4

Patients with IBD should have access to review by the IBD team within a maximum of five working days and be able to escalate/start a treatment plan within 48 hours of review.

Statement 7.2

Patients should be supported in self-management, as appropriate, through referral or signposting to education, groups and support.

Who's doing it well?

Warrington Hospital is a district general hospital with a general population of approximately 330,000 people. Within the last year, they have appointed a second Nurse Specialist to the IBD team.

What was the opportunity?

Patients who were due to escalate their treatment to immunosuppressants or biologics would be booked into a regular nurse clinic slot for education which was sub-optimal.

Tina Law, Senior IBD Nurse Specialist, wanted to provide a dedicated service for those patients who were newly diagnosed, or were needing to start biologics or immunosuppressants, allowing a full discussion of disease, treatments, risks and benefits and to ensure that all pre treatment screening was completed in a timely manner.

What wasn't working?

Consultants did not routinely educate patients about escalated therapy and a nurse was not available to attend clinic on an ad-hoc basis to support. Patients could be waiting several weeks for an available appointment, or the clinic would be overbooked, therefore run late. Routine clinic appointment slots were only 25 minutes long, which Tina felt needed to be longer to ensure the patient understood the relevant information with risks and benefits of treatments clearly explained. Therapy monitoring was suboptimal, due to patient compliance issues.

The idea

A new dedicated clinic template was set up to see 3 patients in 1 hour slots. This allowed time to complete all education and assessments, blood tests and explain monitoring requirements in a relaxed manner and provide time for patients to ask questions. This was intended to reduce the wait for an education appointment, therefore start patients on treatment earlier.

Results

The clinic provided 3 extra clinic appointments.

It meant that routine clinics were not overbooked. Patients had an improved experience and in most cases they were able to be seen the same week for education. Patients have expressed their appreciation for the appointments. From a nursing point of view, the team still educate patients in routine slots if required (as always) but it is beneficial to the clinic not to overbook these lengthy appointments.

Patient compliance with blood monitoring has improved.

New patients are now being referred from endoscopy which improves the patient understanding, again, they are not waiting weeks for a follow up appointment for results.

Based on the IBD Standards requirements for staffing, the service was successful in having another nurse approved. Improved access for patients, robust monitoring of biologics and thiopurines and continuity of service were all considerations within the original business case. Having a new member of staff starting in post meant Tina could build in the capacity for this clinic. It has now been rolled out to the Trust's other site, to prevent patients having to travel to the main hospital. Pre and post waiting times are currently being audited.

Its important to me that we improve both patient and clinician experience. I was very frustrated when having to overbook patients for education, feeling that I wasn’t giving them the best experience and very conscious that I may have rushed some of the important information related to their medications. I am really pleased that we have been able to set up this clinic, providing an improved experience for all. Consultants have embraced the clinic and also appreciate its value, regularly giving positive feedback from patients who have attended.

Tina Law, Senior IBD Nurse Specialist

Recently I met with Tina Law, the dedicated Gastro nurse who supports the care and treatment of patients like me with Crohns or Ulcerative Colitis. She spent a long time explaining my condition, the treatment available, the specifics about starting a specified treatment that was causing me anxiety. Her knowledge and support were invaluable to me and the time she took to care for and explain about treatments was exceptional. The hospital is lucky to have such a capable and caring professional. It mattered a great deal to me, and I am sure others will feel the same, to get the relief and benefits of having an expert like Tina Law go through the details of what the treatments will do, side effects and positive benefits. I have suffered my condition for a long time and having the chance to spend time with someone else with such huge experience mattered more than I can express.

Patient Feedback