LAUSR

Introduction The role of the IBD nurse in reviewing suspected new patients is evolving with the onset of more rapid access clinics. The purpose of the study was to evaluate how reliable the use of a specific pathway from primary care was in identifying IBD patients vs IBS using the IBD nurse to reduce the referral to diagnosis time. Methods A retrospective examination of data from a nurse-led rapid access clinic was used to determine if the use of an IBD vs IBS pathway was successful in reducing referral to treatment times but also to highlight if improvements to the service enabled a more satisfying patient experience? Over an 18 month period, 400 patients (M=140, F=260) between the ages of 16–45 were reviewed in the rapid access clinic within 7 days of the referral. Previously the referral to diagnosis/treatment time was around 30 weeks, with patients waiting up to 18 weeks to be seen in secondary care. Initially the faecal calprotectin on the referral pathway was set at 50µg/g. Following triage by the IBD nurse the patients referred with a faecal calprotectin between 50–100µg/g (N=100) were asked to repeat the stool sample. Results The patients were reviewed and sent for investigation within 6 weeks of consultation with 56.5% of patients having endoscopic evaluation and only 28% of those patients received any diagnosis. When the faecal calprotectin cut off was raised to 100µg/g the result then increased to 32% for IBD, with a further 17% with a differential diagnosis. The differentials included 3 colorectal cancers (not on 2WW), gynaecological problems, mesenteric panniculitis and 12.5% had microscopic colitis. Conclusions The referral to diagnosis time was reduced from 30 weeks to on average 9 weeks. There were around 25 new referrals a month with patients being seen within 7 days. The IBD nurse is perfectly placed to triage and review suspected new patients improving patient experience as the waiting times are reduced and the IBD nurse was capable of identifying and managing differential diagnoses. The challenge has been finding an optimum cut off for the faecal calprotectin so to eliminate low sensitivity and specificity for aiding diagnosis of IBD but also engaging with primary care colleagues to support the referral pathway. It is recommended that the referral pathway is a suitable method for suspected IBD patients to be seen but that more education within primary care is required to improve patient experience and increase appropriate patient referrals.