Abstract Background There is a well-designed pathway to ensure rapid follow-up and treatment of patients with newly diagnosed colorectal cancer at endoscopy. However, such a pathway does not exist for patients who are newly diagnosed with Ulcerative Colitis (UC) during endoscopy. As a result, these patients often experience significant delays with starting treatment and attending specialist follow-up. Delays are driven by increased demand for gastroenterology services, lack of outpatient capacity, the complex management of UC and administrative inefficiencies. Starting prompt treatment and timely follow-up are key to improving patient outcomes and avoiding complications1,2. Studies have shown initiation of early treatment is associated with better disease control, reduced flares and decreased hospital admissions1,2. The aim of this project was to develop a structured care pathway to reduce delays when initiating treatment and arranging follow-up for patients with newly diagnosed UC at endoscopy. Methods We applied a multi-faceted intervention consisting of: 1. A clinical flowchart that guides immediate treatment of patients with new diagnosis of UC at endoscopy based on severity of disease (See Figure 1). 2. A Standard Operating Procedure document to support staff when arranging follow-up appointments and ensuring communication between teams. 3. Two dedicated weekly slots in the Inflammatory Bowel Disease (IBD) clinic for newly diagnosed UC patients We completed a 6-month audit from March to August 2025 looking at endoscopy data for patients with newly diagnosed UC against how quickly treatment was being initiated. Results From March to August 2025, a total of 207 endoscopy records were obtained. After screening to exclude duplicate and paediatric data 147/207 records were left. Patients with new UC accounted for 15/147 records (10.2%). 10/15 patients were started on treatment on the same day as endoscopy. For the remaining 5/15 patients, results for starting treatment showed unclear starting time (1/5), commensal of emergency treatment either as a flare or inpatient stay (2/5), or multiple days after diagnosis (2/5). Conclusion Our data analysis showed 2/3 of patients were started on immediate treatment at diagnosis, however, there were instances where patients either needed emergency treatment or had delayed treatment commensal post endoscopy, suggesting areas for improvement. A protocolised pathway and Standard Operating Procedure help to reduce treatment delays, ensure patients are getting earlier specialist input and improve patient satisfaction whilst optimising service delivery. References: 1. Noor NM, Sousa P, Paul S, Roblin X. Early Diagnosis, Early Stratification, and Early Intervention to Deliver Precision Medicine in IBD. Inflamm Bowel Dis. 2022;28(8):1254-1264. doi:10.1093/ibd/izab228 2. Jayasooriya N, Baillie S, Blackwell J, et al. Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease. Aliment Pharmacol Ther. 2023;57(6):635-652. doi:10.1111/apt.17370 Conflict of interest: Dr. Karelia, Shivaali: No conflict of interest Joshi, Neerav Mukesh: No conflict of interest Fraser, Bridgette: No conflict of interest Figure 1:
Karelia et al. (Thu,) studied this question.