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Setting up a comprehensive Intestinal Failure service

Dr James Stewart on behalf of the Digestive Diseases Centre, Leicester Royal Infirmary for excellence in service delivery in setting up a comprehensive Intestinal Failure service 2019.

Authors and Institution

Dr J Stewart Clinical Lead for Nutrition
Dr Dan Rogers, Consultant in Clinical Nutrition
Melanie Baker Senior Dietitian

Digestive Diseases Centre, Leicester Royal Infirmary

Challenges

Leicestershire has a population of 1 million. The burden of both inpatient Intestinal Failure and home parenteral is growing exponentially. Faced with a growing number of intestinal failure referrals it was essential to expand a small team of one gastroenterologist, one nurse and one dietitian into a multidisciplinary team that meet the demands of both Type 2 & 3 intestinal failure.

How we managed the challenges

Over a period of several years we expanded the team from the above to one containing three Clinical Nutrition Consultants, three Senior Dietitians, three Specialist Nutrition Nurses, two Specialist Surgeons, a Consultant Biochemist, and a Consultant Microbiologist. This required careful negotiation and persuasion at Trust level of the need for a comprehensive Intestinal Failure service.

Evaluation and Outcomes

The team expanded to include the staff outlined above and developed a regional network with Coventry. We developed regular intestinal MDT meetings and doubled our Home Parenteral patient clinics. This engendered referrals from all over the country and regional educational meetings. Leicester now has a national nutrition profile to rival St Marks and Salford. As a Regional Nutrition Centre we have received referrals from Scotland, the South of England and even the Netherlands. (www.clifnet.org)

Proper care can only be delivered by highly developed and skilled teams. The necessity for such teams need to be made a priority at Trust level such that there can appropriate support to develop these roles. Once a full MDT team is established that raises the profile of the regional service and engenders referrals from all over the country and beyond.