Multidisciplinary clinician perspectives on reducing avoidable inflammatory bowel disease admissions: A mixed methods study
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Background
Unplanned hospital admissions are costly outcomes in inflammatory bowel disease (IBD). However, the extent to which they are avoidable remains unclear. This study explored multidisciplinary clinicians’ perceptions of admission types, causes, barriers, and enablers to their prevention.
Methods
A mixed-methods study using explanatory sequential design integrated findings from an online survey and follow-up semi-structured interviews. Clinicians ranked causes and barriers to preventing admissions, analysed by descriptive statistics and Friedman and Wilcoxon rank tests. Thematic Framework analysis, using Candidacy Theory, analysed qualitative data from the survey and interviews.
Results
Survey: 145 started and 80 (55.2%) were included. For all unplanned IBD admissions, ranking of all reasons were significantly different (p <0.001). An unpreventable disease progression was ranked most important (mean rank [MR] 32.20/100) ( p <0.05), followed by missed opportunities for earlier intervention (MR 22.39/100) and patient access issues (MR 19.52/100).
Interviews: 13 clinicians were interviewed. Three overlapping themes summarised definitions of avoidable and preventable IBD admissions: (1) Missed opportunities in outpatient or primary care, (2) critical delays in specialised care, and (3) system constraints blocking timely action. Key challenges in preventing admissions related to patient navigation of services, organisational barriers, provider decision-making, and structural issues that impede access to care.
Conclusions
Clinicians perceive most avoidable admissions not as a failure of individuals, but a reflection of broader service inefficiencies and inequities. Reducing IBD admissions requires systemic investment and improvements in care navigation, rapid-access pathways, professional decision-making, patient education and service integration.
Key messages
What is already known?
Unplanned hospital admissions for inflammatory bowel disease (IBD) are a frequent and costly outcome, often linked to challenges in outpatient care. Clinicians’ perspectives on why these admissions occur and how they could be prevented are not well understood.
What is new here?
This study shows that clinicians view most avoidable admissions not as individual failures, but as the result of system-wide inefficiencies. They identify missed opportunities for earlier intervention, critical delays in accessing specialist care, and resource constraints as key drivers.
How can this study help patient care?
These findings can help services build better rapid-access pathways for patients experiencing flares and justify targeted investment in IBD care. This shifts the focus from individual blame towards systemic issues.
Lay summary
Unplanned hospital admissions for inflammatory bowel disease (IBD) are common, but it is unclear to what extent they are avoidable. This study explored gastroenterologists, IBD nurses, surgeons and allied professionals’ perspectives of unplanned IBD admissions by an online survey and interviews.
