Team Leader

  • Lucy Leadbetter – Gastroenterology Dietitian
    (Amy Smith – Gastroenterology Dietitian)

Team Members

  • Lucy Leadbetter – Gastroenterology Dietitian
  • Kirsty Martin – Dietetic Assistant
  • (Amy Smith – Gastroenterology Dietitian)

What was the problem you were trying to address?

Current local practice was not in line with national guidelines for the management of Coeliac disease – this was demonstrated by local audit.  Current practice was that the coeliac patients were seen within a nurse led clinic at diagnosis and review.

Main issues included:

  • Less than 50% of newly diagnosed patients had initial assessment within the standards set out by CREST and BSG i.e. within 3 months of diagnosis
  • 74% of patients did not have a complete weight history taken nor did they have their BMI analysed
  • Only 14% of patients were referred to a dietitian at point of diagnosis

Overall, the existing coeliac service did not allow patients to be seen rapidly by a dietitian following diagnosis of coeliac disease and regular dietetic follow up was inconsistent.  Current evidence identifies that patients with coeliac disease prefer for their education and support to be from a dietitian, who is able to provide individualised support and close dietary monitoring.

How did you create your project plan?

Local audit was carried out to identify how current local practice compared with national standards. The key findings are summarised above and demonstrated that a review of the service was needed.  Analysis of existing practice at other Trusts was carried out and a Business case was created to propose the use of a dietetic led coeliac service at Aintree. The existence of these in other local and national Trusts had been widely recognised as successful. This was created in conjunction with gastroenterology consultants.

Key Actions

  • Local audit of existing nurse led service
  • Review of other dietetic led coeliac services and local meeting s to discuss options
  • Business case submitted with proposal for an Aintree dietetic led coeliac service – successfully approved

Main Outcomes

Creation of a local care pathway for the dietetic led management of coeliac disease – following diagnosis with coeliac disease, patients are referred immediately for dietetic follow up.  All care is managed by dietitian, including biochemistry monitoring and DEXA scan requesting.  Key improvements include:

  • Patients are seen by a dietitian within 12 weeks (often sooner) of diagnosis.  This is in the form of a group meeting, unless patients opt for an initial individual assessment.  This ensures waiting times are reduced significantly.
  • Patients are then reviewed at 3, 6 and 9 months post diagnosis by a dietitian, they are all then seen in annual review clinic, unless more frequent review is needed.  Patients can be referred back for consultant assessment by the dietitian at any point.
  • Dietitians trained to request DEXA scans and biochemistry monitoring to meet national guidelines for the surveillance of these in patients with coeliac disease.
  • All patients have body weight and BMI reviewed by a dietitian at each assessment
  • All patients have regular and appropriate dietary support in their management

These changes mean that the new service is now inline with BSG and CREST guidelines for the management of coeliac disease.

How are you going to maintain the improvement?

Audit was carried out 18 months after the initiation of the new clinic.  This demonstrated significant improvements in waiting times (all now within national and local standards) and the achievement of the recommendations for management of coeliac disease (including regular BMI / weight checks, thorough dietary analysis at regular intervals and regular monitoring of key biochemical parameters, including iron, folate and vitamin B 12 levels.

Patient satisfaction survey is planned for the forthcoming year to gather patient opinion on the new service, which will be used to support any changes necessary

Tips for others planning similar projects

Ensure use of MDT skill mix to be able to implement changes to service.

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