Gastroenterologist Consultation Is Uncommon but Associated with Improved Care Among IBD Patients Presenting to Emergency Departments in Winnipeg Hospitals

Abstract

Abstract Objective To describe the patterns of care when persons with inflammatory bowel disease (IBD) present to the Emergency Department (ED) and post-ED follow-up. Methods We linked the University of Manitoba IBD Epidemiology Database with the Emergency Department Information System of the Winnipeg Regional Health Authority from January 1, 2010 to December 31, 2012. We then generated a list of all ED attendances by persons with IBD at four of six hospitals within the City of Winnipeg (two academic and two community hospitals). The charts were reviewed by two investigators extracting data on testing, consulting and treatment undertaken in the ED as well as postdischarge follow-up. We focused on outcomes among those attending the ED but not admitted to hospital. Results Of 1275 IBD patients with a first visit to the ED, 523 (41%) were for IBD-specific complaints. Three hundred and twenty-seven (62.5%) were discharged from the ED without an in-hospital admission. Nearly 80% had an identified gastrointestinal (GI) specialist (either gastroenterologist or GI surgeon) involved in their care. A gastroenterologist was consulted in the ED 20% of the time. Follow-up post-ED with a gastroenterologist was only documented in 36%. For those who saw a gastroenterologist in the ED, there was more likely to be a change in medications and follow-up arranged with a gastroenterologist. ED consultation with a gastroenterologist was the only predictor of seeing a gastroenterologist in follow-up post-ED. Conclusions ED gastroenterology consultation is more likely to effect IBD management change. When discharged from the ED gastroenterology, follow-up should be arranged and documented.