Improving the use of the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) at a district general hospital

Introduction

Endoscopy provides an essential diagnostic tool in inflammatory bowel disease (IBD). Several scoring systems have been designed for classifying endoluminal inflammatory activity, and their use is recommended to provide a standardised basis for assessment. The purpose of this retrospective study was to assess the use of the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score during endoscopy for patients with ulcerative colitis (UC) at a district general hospital.

Methods

A patient list was generated from the hospital endoscopy software looking at a six month period between March and August 2021. This list was filtered to include all patients with UC undergoing a flexible sigmoidoscopy or colonoscopy. Using patient records and a data collection tool, data was gathered on a number of parameters, including the use of the UCEIS score. To raise awareness of the score and provide further education, findings were presented at an endoscopy user meeting and a surgical clinical governance meeting. Posters were then designed to provide a visual aid and prompt, which were displayed in all endoscopy theatres. Use of the score was re-audited three months later.

Results

100 patients were reviewed in the first cycle. of these, 40% had a UCEIS score documented on their report. 45% of patients with proctitis were scored, whilst 52% of patients with more extensive disease were scored. No patients deemed in remission had a score documented. 83% of scoring endoscopists were consultant gastroenterologists and 17% were clinical endoscopists. No procedures performed by either surgeon endoscopists or locum staff had scores documented. In the second cycle, 42 patients were reviewed with 76% receiving a UCEIS score. 80% of procedures performed by surgeon endoscopists and 55% performed by locum staff had a score documented respectively. 50% of patients with proctitis and 90% of patients with more extensive disease had a documented score.

Conclusions

Overall, initial use of the UCEIS score was poor, with surgeon endoscopists and locum staff found to never use the score. This was thought to be due to a lack of awareness as these clinician groups may not routinely clinically manage patients with IBD. Following the intervention, there was a near two-fold increase in overall use of the UCEIS score with marked improvement in use amongst the surgical and locum endoscopist groups. The authors recommend further education to new endoscopists and regular locum staff to continue to improve its use. This will help ensure more standardised clinical practice and subsequent management of patients with UC.