Find out more at www.calprotectin.co.uk 9 Rapid Response From my perspective I am seeing a difference already, because we are able to escalate treatment within a day or two of asking for the calprotectin test to be done. We get the result back immediately, whereas previously there was a wait of around 4 – 6 weeks or even longer depending on when the sample was taken and the capacity in the labs. Hopefully, in the future we will see the benefits of this rapid response in terms of reduced hospitalisations and clinic visits, because patients have had timely interventions. In addition there are reduced calls to the helpline because we know the results and are able to act quickly. Cost Savings Going forward we are hoping to be able to reduce the clinic requirement for patients who are stable, because we will be using all the digital tools to remotely monitor and hopefully reduce the risk of flare up. We will be altering the natural history of the IBD which will be the most powerful thing, but it will take a few years to get the data to support this. As part of the business case we estimated some of the potential cost savings that may be realised by introducing the technology. Based on a relatively small population in one area and then extrapolating up for the CCG, the savings estimate was ~£330K. We know we need further data to support this which will take a few years to collect. More Patient Engagement The benefit of the IBDoc from the clinicians perspective is obviously the speed with which the result comes through. Personally I think there is also more engagement both with patients and within the clinical team, because you are able to follow through on a course of action quickly rather than waiting weeks in between decisions which is more frustrating. The IBDoc is very simple but with a lot of impact on patient care. IT Systems Although the user interface is very simple and straight forward, a big advantage for us would be for the hospital IT system to pull the IBDoc result into the Electronic Patient Record. If this can be achieved then people in all departments and primary care, can also access the result which will help significantly. I am hoping our hospital IT can organise this for us, but COVID has made lots of additional demands, so it may take some time. Regional Adoption The three trusts in our region (including Southend and Broomfield) amalgamated this year, so we need to operate the same pathways and services in each of the centres. At Basildon we have driven the adoption of the IBDoc because we performed the trial and have the experience. With the advent of COVID the requirement to operate more remotely became important, and so this has helped with the adoption in the other centres. We are all operating from the same IBDoc portal, but we have set it up so that we only see our own patients. The patients have a single support group now and they do talk to each other (news travels fast), so it would have been problematic not to offer the same access to the new technology. Remote Monitoring There is a move nationally towards more remote monitoring because of the huge demand for increased capacity, but by relieving some of the resource requirements we can create capacity. So, at the moment we are continuing to operate virtual clinics that were introduced during COVID and will do so for the foreseeable future. There are benefits not only for us but also for the patients in not having to attend the hospital (and find a parking space!). With remote monitoring the virtual clinics are ideal for those patients that are more stable but who we still need to stay in touch with. Before COVID we did do this for some clinics, but I certainly see it expanding.The IBDoc gives us the opportunity to monitor the patients and have the ability to intervene very early on if things start to progress so that the patients don’t have to keep coming into hospital. This ties in very much with the Topol Review published in Feb 2019 which highly recommended personalised care for long term conditions and embraces national objectives to adopt digital care. If we can implement this then it will help us to operate more targeted face to face clinics with the patients who have more complex requirements. Using the IBDoc has increased the engagement from both the patients and the clinical team, and the speed of the results really makes a big impact in decision making and patient management. It doesn’t really add more work because you save time in chasing results and additional support for patients whilst they are waiting for results. The key things are: ■ Prompt result and treatment ■ Patient engagement in long term conditions ■ Personalised treatment” Jacqueline Roscoe, IBD Nurse Specialist Jacqueline Roscoe is one of two full time IBD nurses on the Basildon site, treating patients from the surrounding areas that also include Brentwood, Thurrock, Rayleigh and Purfleet. “We treat adult patients and transitional patients, so those that are 16 – 18 years of age. For the transitional patients we have a shared care system with the specialist paediatric centres either at GOSH or Addenbrookes. Telephone Clinics They operate two telephone clinics for patients. Due to the COVID-19 pandemic capacity in these has increased to around 20 patients a week. There is also a helpline for patients taking around 10 calls and up to 50 emails a day. The nurses also run biologic pre-assessment clinics every week. There is a multidisciplinary team meeting (MDT) once a fortnight and a video capsule endoscopy service for when we want to take a closer look at the small bowel. In the initial comparisons of the IBDoc results to the lab results most data compared really well. For some results the values were quite different, but when we spoke to those patients we found that they were only sampling from one place in the stool. Once we explained they needed to sample from several different places they got better correlation. ......continued
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