Increasing physician-perceived comfort about ostomies in pediatric inflammatory bowel disease: An interprofessional quality improvement project

Abstract

Introduction

Pediatric inflammatory bowel disease (IBD) is a chronic disease with various treatments, including ostomy surgery, which is associated with stigma. Physicians' known discomfort in discussing ostomies can impact medical decision-making and the timing of clinical conversation. This quality improvement (QI) work developed and tested interprofessional tools to increase physician-perceived comfort in ostomy-related discussions at pediatric-IBD focused Learning Health Network site.

Methods

A multidisciplinary team of GI/IBD psychologists, ostomy nurses, and child life specialists developed tools designed to increase physician-perceived comfort in ostomy discussions at an institution that participates in ImproveCareNow, a pediatric-IBD Learning Health Network. Two Plan Do Study Act (PDSA) cycles were completed. PDSA Cycle 1 involved IBD attending physicians (n = 4) for 8 weeks and PDSA Cycle 2 involved GI medical fellows (n = 7) for 12 weeks. Each PDSA cycle involved (1) baseline information, (2) resource education, and (3) tracking of physician-perceived comfort.

Results

For IBD attendings, average physician-perceived comfort talking about ostomies increased from 68.8% to 83.3%. For GI medical fellows, average physician-perceived comfort increased from 41.4% to 62%.

Conclusions

Ostomy surgery in pediatric IBD is a complex medical decision with notable stigma, demonstrating a pressing need to facilitate non-stigmatizing and psychosocially mindful clinical discussions. This QI project demonstrated how interprofessional education and resources increased physician-perceived comfort in ostomy discussions among IBD attendings and GI medical fellows at an ImproveCareNow site.