In a first-of-its-kind study, UCSF researchers assessed factors prolonging length of stay (LOS) for a diverse population of hospitalized patients with acute severe ulcerative colitis (ASUC) and identified interventions to reduce LOS for these patients.
“Biologic medications are the cornerstone of rescue therapy management for these very sick patients,” said UCSF gastroenterologist Sara Lewin, MD, the study’s lead author. “Delays in initiating biologics are the biggest predictors of increased length of stay.”
Interventions for reducing LOS
The researchers reviewed the charts of all adult ASUC-related hospitalizations at UCSF from July 1, 2014, to December 31, 2017. For the 95 patients who did not require colectomy during their stay, the team identified multiple predictors for LOS of seven or more days. Two notable predictors were biologic naïve treatment status and delayed initiation of inpatient biologic rescue therapy.
The UCSF team found several strategies that could reduce LOS for hospitalized patients with ASUC, including early communication and patient education about biologic therapy in both inpatient and outpatient settings. Another key factor for reducing LOS was prompt inpatient screening for latent tuberculosis and hepatitis B infection, a prerequisite for initiating biologics.
“Early patient education is so important, both in the hospital as well as by outpatient providers, so that patients understand how ulcerative colitis is best managed and that data supports the use of biologics,” Lewin said. “Mobilizing the care pathway to get patients started on biologics as soon as possible makes a significant difference in terms of getting patients out of the hospital.”
An environment of collaboration at UCSF
Lewin and the other researchers regularly collaborate on studies with the UCSF Division of Hospital Medicine. “My area of interest is looking at outcomes for hospitalized patients with ulcerative colitis,” Lewin said. “The strength of the Division of Hospital Medicine lends itself well to improving the quality of care. Our team collaborates with our hospital medicine colleagues to understand the problems and then parlay [our insights] into actionable solutions.”
Lewin and UCSF colleagues published a 2019 study on quality improvement for inpatient management of ulcerative colitis. They found that using standardized treatment algorithms reduces care variation, that this protocol does not require inflammatory bowel disease specialists to implement, and that its use therefore optimizes delivery of evidence-based care.
“That study is another example of using metrics to improve the quality and consistency of care,” Lewin said. “It required quite a bit of collaboration with our hospital medicine colleagues – who embraced it with open arms.”
To learn more
UCSF Colitis and Crohn's Disease Center
Phone: (415) 353-7921 | Fax: (415) 502-2249
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