Cost-effective inflammatory bowel disease flare pathway with nurse-led triage and rapid access intestinal ultrasound reduces hospital resource use with high patient satisfaction

Background Timely treatment of inflammatory bowel disease (IBD) flares improves outcomes, but quick differentiation from other symptom causes is challenging. We implemented a clinical care pathway (CCP) using protocolised nurse-led triage and rapid access intestinal ultrasound (RAIUS) for early flare management, aiming to improve patient outcomes and satisfaction, and reduce healthcare utilisation. Methods Prospective observational study from November 2022 until June 2023. IBD nurse triaged patients using a symptom severity-based protocol. Based on clinical urgency, patients were discussed with their specialist, referred for RAIUS, or planned for hospitalisation. Data collected included outcomes, healthcare utilisation impact, clinical coding data, patient surveys. Results There were 211 episodes of care (EOCs), most (78%, 165/211) for flare symptoms, with medication optimisation in 36% (59/165), reassurance of remission in 41% (67/165), aperients for faecal loading in 12% (19/165), and further investigations in 5% (8/165). RAIUS utilised in 27% EOCs (56/211), confirming active disease in 32% (18/56), response/remission in 43% (24/56), and faecal loading in 23% (13/56). Of the EOCs, 10% (20/211) avoided unplanned hospitalisations, 58% (123/211) avoided urgent clinic reviews, and 32% (68/211) had no direct impact, with AUD$146,418 estimated net savings over 30 weeks. There were lower numbers of Emergency Department presentations (14 vs 44) and hospital admissions (10 vs 38). Six unplanned hospital presentations occurred within 30 days of CCP engagement (five after-hours). More patients were “satisfied” or “very satisfied” (32/60 pre- and 51/60 post-CCP). Conclusion Our novel CCP reduced hospital resource utilisation, with high patient satisfaction and significant cost savings.