Benefits of implementing a rapid access clinic in a high-volume inflammatory bowel disease center: Access, resource utilization and outcomes

Table 1 Characteristics of patients contacting the rapid access clinic vs emergency department

	RAC visits (n = 488)	Emergency departmentvisits (n = 135)
CD/UC (n)	334/154	97/38
Men/Women (%)	41.3/58.7	60.7/39.3
Age (mean ± SD, yr)	39.3 ± 14.8	45.2 ± 18.4
CD localization L1/L2/L3/L4 (%)	25.1/27.9/46.0/1.0	18.4/19.4/62.2/-
CD behavior B1/B2/B3 (%)	66.7/17.6/15.7	38.8/31.6/29.6
CD perianal (%)	22.7	10.2
UC location E1/E2/E3 (%)	8.8/30.4/60.8	-/27.8/72.2
Biological therapy (%)	60.6	42.9
Previous resective surgery (%)	19.8	35.6

RAC: Rapid access clinic; CD: Crohn’s disease; UC: Ulcerative colitis.

Table 2 Comparison of resource utilization between rapid access clinic vs emergency department visits

	RAC resource utilization (%)1	ED resource utilization (%)2	P value
CRP	90.9	98.5	NS
FCAL	73	10.4	< 0.001
C. diff stool test	43.1	51.1	0.03
Stool Culture	41.9	48.9	0.06
TDM	14.7	0.0	< 0.001
Colonoscopy	17.9	26.7	0.005
Flexible sigmoidoscopy	6.7	14.8	< 0.001
CT abdominal	6.0	65.7	< 0.001
MRI	2.1	2.2	NS
Abdominal ultrasound	11.3	3.7	< 0.001
Gastroenterology consultation	-	100
Internal medicine consultation	-	50.4
Colorectal surgery consultation	-	37.8
Other consults	9.8	9.6	NS

¹Four hundred and nineteen patients presenting for MD or nurse visit for RAC clinic visit;

²One hundred and thirty-five patients presenting for ED visit, with no previous access to RAC services. RAC: Rapid access clinic; ED: Emergency department; CRP: C-reactive protein; FCAL: Fecal calprotectin; TDM: Therapeutic drug monitoring; CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 3 Inflammatory bowel disease related treatment change based on rapid access clinic/emergency department visit

	RAC visits (n = 488)	Emergency department visits (n = 135)
Treatment change	54.4%	58.5%
Systemic steroid start or dose adjustment	21.0%b	42.2%b
Biologic start	5.7%	2.2%
Biologic optimization	6.2%

^bP < 0.001. RAC: Rapid access clinic.