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Integrated Clinical and Research IBD Unit

Integrated Clinical and Research IBD Unit

Professor Shaji Sebastian on behalf of IBD Hull – Integrated IBD Unit

 

Authors and Institution (listed with their role)
  • Professor Shaji Sebastian, IBD Service Lead
  • Dr M Giaffer, Consultant IBD
  • Sally Myers, Senior IBD Research Nurse
  • Emma Whitehead, Senior IBD Nurse
  • Mr Greg Haire, Divisional Manager
  • Mr James Illingworth, R&D Manager
  • Ms Amy Wilkinson, IBD Administrator and data co-ordinator

 

Summary of the service story

Evidence shows research-active organizations consistently deliver better outcomes to all patients they treat, not just those involved in health research trials. We wanted to ensure research is embedded in all aspects of care delivered to our IBD patients.

 

Challenges
  • Audits in 2006 and 2008 showed unacceptably high admission rates, colitis-related dysplasia and cancer and surgery rates in Crohn’s disease despite service reorganization.
  • The pressure of clinical service delivery meant a limited focus on research in the unit. Majority of patients did not have the opportunity to participate in IBD research with Only 3% of our IBD patients were involved in research

 

How we managed the challenges
  1.  A 5-year strategy developed to integrate clinical and research teams and received support from research and clinical managers
  2. Buy in from clinical and research managers
  3. Ownership for research integration into clinical care to all members of the team
  4. Research embedded into job plans of clinicians and IBD nurses and research nurses embedded into routine care
  5. Engagement exercise with a local patient group
  6. Every clinical encounter used for research opportunity
  7. Dedicated immunomodulatory unit to ensure continuity and consistency of care
  8. Protocolled clinical care delivery accurate and rigorous monitoring and data management simulating research processes
    1.  Risk stratification in every patient
    2. Safety bundles in therapy introduction
    3. Timely introduction of therapies with named nurse
    4. Early assessment of response mimicking clinical trial setting
    5. Objective markers of response assessment
    6. Treat to target principles adopted since 2011
    7. Learning network through feedback-loop principles

 

Evaluation and Outcomes
  1.  Creation of the first integrated clinical and IBD Unit in UK – IBD Hull
  2. Every member of the clinical team work alongside the research team in synchrony
  3. Improved outcomes over the last 5 years
    1. 45% reduction in emergency admission rates over 5 years
    2.  High fistula closure rates- well above published rates in the literature
    3. Low CAC/ dysplasia rates – Well below published rates in the literature
    4.  Low chronic steroid use rates
    5. 80% reduction in emergency surgery rates in 5 years
    6. An increasing proportion of laparoscopic surgery and primary anastomosis, lower complications rates
    7. Lowest proportionate long term TPN rates
  4. Significant increase in patient participation in research 71% of our patient has participated in at least one study in last 2 years

  5. Patient-led research projects

  6. Research output

    1. Leading recruiters in high profile national and international studies

    2. Leading multicenter national and international studies from IBD Hull

    3. Research publications adopted into clinical care

  7. Self-sustaining funding model
    1. Self-funding unit
    2. Research income support clinical care and clinical care resources support research

    3. Sustaining and growing despite NS financial pressures

  8. Patient satisfaction surveys consistently give positive messages: “not left in the gap between clinical care and research”, “seamless journey in care”

  9. Staff satisfaction and progress

    1.  All medical, nursing staff has at least 1 peer reviewed full publication

    2. Nursing PI

    3. Nursing academics and research degrees

    4. Patient-led research

  10.  Recognition for the IBD Hull Model

    1.  NIHR-RCP award

    2.  Multiple NIHR team awards

    3.  Exemplar in NIHR event integrating IBD Nursing and IBD research

    4.  Recognition from EECO

Learning Points
  • Integration of clinical care and research is a model to improve seamless care of IBD patients
  • Equal partnership working between research and clinical care teams can deliver integration
  • Integrated unit leads to better clinical outcomes

 

Supporting information

Research Recruitment in last 2 years

Income generation from IMIC

Income generation from research

Awards

1.     Ozdemir BA. Research Activity and the Association with Mortality. PLoS One. 2015; 10(2): e0118253

2.     Jonker L, Fisher SJ. The correlation between National Health Service trusts’ clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study. Public Health. 2018 Apr; 157:1-6.

3.     Jonker L, Fisher SJ, Dagnan D. Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: Results from a retrospective cross-sectional study. J Eval Clin Pract. 2019 Feb 19. doi: 10.1111/jep.13118

Contact details for members interested in getting more information

IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ

[email protected]

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