N41 ”Taming the Beast”: Tackling the ever-increasing demands associated with initiating advanced therapy for Inflammatory Bowel Disease.

Abstract Background The increase in advanced therapies for Inflammatory Bowel Disease (IBD) continues to challenge service capacity. At St. Mark’s Hospital, staff constraints and physical space limitations were identified as barriers to meeting IBD UK Standard 41 which emphasises timely initiation of treatment and evidence-based monitoring. We evaluated the impact of a team-led redesign, including expansion of the infusion unit from five to six chairs, on capacity, efficiency, and quality of care. This represents Stage 1 of an ongoing quality improvement programme. Methods A six-month service improvement initiative (September 2024–February 2025) implemented multiple interventions: optimisation of staff skill mix, scheduling adjustments to treat more patients simultaneously, displaying rates of nonattendance and waiting times in a patient facing area and the introduction of a patient self-assessment proforma completed prior to infusion. The proforma captured IBD-related symptoms over the preceding 24 hours, enabling clinical assessment, early flare and/or loss of response to therapy detection, and clinical escalation if needed. Audit data, waiting times, patient feedback and adherence to IBD Standards were analysed pre- and post-intervention. Results Capacity increased from 20 to 25 patients per day by February 2025 following full activation of the six-chair unit. Waiting times to start treatment reduced from 6 to 2 weeks. Written feedback on the self-assessment proforma was received from 143 patients: the majority reporting high satisfaction and a positive experience. Eight patients (5.5%) gave negative feedback, concerns were reluctance to write, literacy challenges, language barriers, or a preference—particularly among older patients—for verbal reporting. Conclusion Combining an extra chair with workflow changes reduced waiting times from six weeks to two weeks, meeting service benchmarks and aligning more with treatment timeframes advocated in the IBD Standards. A self-assessment proforma streamlined assessment, supported early identification of treatment-response concerns or flares, and was generally well received by patients. Audit findings show increased compliance with timely review and monitoring requirements. Staff reported improved workload, and patients expressed confidence and satisfaction in their care. These outcomes provide a strong foundation for Stage 2, focussed on digitalising the self-assessment process and sustaining long-term capacity growth in advanced therapy delivery. References: IBD UK Standards Group. IBD Standards: what high-quality care should look like for people with IBD. IBD UK; 2019. Accessed November 17, 2025. https://ibduk.org/ibd-standards Conflict of interest: Rejee, Christy: No conflict of interest Younge, Lisa: No conflict of interest Tyrrell, Tracey: No conflict of interest Misra, Ravi: No conflict of interest