Introduction

Interprofessional teamwork is essential in modern healthcare, with interprofessional training wards established since 1996 to enhance professional collaboration and communication. Despite their importance in optimizing patient care and training, research into patient outcomes in these wards is limited and often restricted to patient satisfaction. This study expands existing research by comparing patient outcomes in the interprofessional training ward Regensburg (A-STAR) and conventional wards, hypothesizing that interprofessional training wards offer no disadvantage to patient outcomes.

Aims & Methods

This comprehensive study, which delved into various aspects of interprofessional training wards, was conducted at the University Hospital Regensburg from October 2019 to December 2023. To ensure a robust analysis, we assessed patient outcomes, cost efficiency, patient and family satisfaction, and gainage of interprofessional competence in the interprofessional training ward A-STAR. Our data collection methods were diverse, including digital and paper-based anonymous standardized questionnaires (Collaboration and Satisfaction About Care Decisions (CSACD), Family Satisfaction in the Intensive Care Unit—(FS-ICU)), and information from the clinical data system.

Results

The study analyzed outcomes from 1,482 A-STAR and 5,752 conventional ward patients, revealing that the clinical outcomes of A-STAR patients, such as discharges against medical advice, complication-driven readmissions, ICU transfers, and mortality rates were similar to those in conventional wards. A-STAR was also more cost-effective, generating higher profits per case due to increased revenues and reduced material costs. A-STAR received high satisfaction ratings from patients and family members regarding treatment and decision-making. Moreover, medical students and nursing apprentices reported significant improvements in their ability to make interprofessional medical decisions after their training periods (medical students: mean difference -8.23, p=0.004; nursing apprentices: mean difference -9.5, p=0.003).

Conclusion

Interprofessional training wards like A-STAR ensure comparable patient care to conventional wards and enhance the educational experience for healthcare students. Our findings demonstrate that these wards are cost-effective and beneficial for patient and family satisfaction. This underscores the importance of integrating interprofessional training wards into medical curricula, as they significantly improve interprofessional collaboration and decision-making skills, which are crucial for patient safety and fostering a positive team atmosphere. In light of these compelling results, the study strongly advocates for the expansion of such training models in healthcare settings to better equip future professionals for the complexities of modern medical practice.

Introduction

Interprofessional collaboration is essential in modern clinical practice. Since the introduction of interprofessional training wards (IPSTAs) in 1996, these units have aimed to strengthen teamwork and communication across professional boundaries. This study, conducted at Regensburg University Hospital, evaluates and compares patient outcomes, cost-effectiveness, cross-sector care quality, interprofessional collaboration, and satisfaction among patients, families, and caregivers between the A-STAR interprofessional training ward and conventional wards.

Aims & Methods

The study was conducted at the A-STAR interprofessional training ward and at conventional gastroenterology-focused wards of Regensburg University Hospital between October 2019 and October 2025. Anonymized, standardized questionnaires were utilized to assess clinical outcomes, cost efficiency, and satisfaction, employing instruments such as the Collaboration and Satisfaction About Care Decisions (CSACD) and the Family Satisfaction in the Intensive Care Unit (FS-ICU) tools. Feedback on cross-sectoral care transitions was obtained from both general practitioners and patients. Furthermore, between October and December 2024, nursing trainees, medical students, nursing staff, and physicians from both the A-STAR ward and the conventional wards were systematically observed during weekday shifts, with the duration and content of their activities systematically documented.

Results

The analysis included 1,514 A-STAR patients and 5,847 from standard wards. Clinical outcomes, such as discharges against medical advice, readmissions due to complications, and mortality, showed no significant differences between groups. However, A-STAR demonstrated higher cost-efficiency, with lower material costs and increased DRG revenue per case. Satisfaction among patients, families, and caregivers was significantly higher on the interprofessional ward. After discharge, only 3.03% of A-STAR patients developed new complaints compared to 22.45% of patients from the normal ward (χ²=6.431; p=0.011). No A-STAR patients (n=32) required post-discharge medication adjustments by their outpatient physicians, whereas 12.63% of patients from the normal ward did (χ²=4.464; p=0.035). Interprofessional interactions tended to last longer on the A-STAR ward (median: 47 minutes; IQR: 60) compared to conventional wards (median: 36 minutes; IQR: 29; p = 0.083, U = 38.500, Z = -1.731). Contacts with physiotherapists were significantly longer on A-STAR (median: 19 minutes; IQR: 60) than on conventional wards (median: 0 minutes; IQR: 1; p < 0.001, U = 13.000, Z = -3.426).

Conclusion

The implementation of the interprofessional A-STAR ward at Regensburg University Hospital maintained clinical safety while improving cost-efficiency and significantly enhancing patient, family, and caregiver satisfaction. Patients treated on A-STAR experienced fewer post-discharge complications and medication adjustments. Longer and more intensive interprofessional interactions, especially with physiotherapists, may have contributed to these positive outcomes. A-STAR demonstrates that structured interprofessional care can add measurable value to clinical practice without compromising patient outcomes.

Disclosure

All authors are employed at the department where the A-STAR interprofessional training ward is implemented.

Introduction

Eight hospitals in the southwest of the Netherlands collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP is a decision-support tool that provides guidelines for medication prescribing, procedures, treatment adjustments, and recommendations for follow-up.

Aims & Methods

This study aimed to evaluate the effect of a CP on patient outcomes and healthcare utilization.
A longitudinal multicentre non-randomised cohort study with a baseline observation period (December 2020 – December 2021) and a follow-up period (March 2022 – March 2023) was conducted, in which adult patients with IBD treated with biologics or small molecules were included. Outcomes were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set from electronic health records or through validated questionnaires. Missing data were handled using single imputation nested within a bootstrap procedure. Effect of the CP on these outcomes were analysed with case-mix adjusted (generalized) linear mixed models.

Results

A total of 1,173 patients participated in the study, with the majority being female (55%) and a median age of 45 years (IQR 33-58). Most patients had Crohn's disease (64%). The CP was associated with a 0.22 increase on the ibd-control-8 score (β=0.22, p=0.28), and an increase on the probability of achieving endoscopic/radiologic (β=0.14, p=0.29), biochemical (β=0.18, p=0.22) and patient-reported remission (β=0.19, p=0.21). Probability of clinician-reported remission decreased slightly (β=-0.09, p=0.59). Emergency room visits (β=-0.36, p=0.13), hospital admissions (β=-0.41, p=0.10), and length of stay (β=-0.09, p=0.56) reduced, although these associations were not significant. The CP had no effect on quality of life (β=0.00, p=0.83), anaemia probability (β=-0.01, p=0.95) or on nutritional status (β=-0.01, p=0.34).

Conclusion

A CP for the management of IBD with biologicals and small molecules has clinically significant potential to reduce healthcare utilization, while improving patient-reported disease control, and disease remission. These results emphasize that clinical care pathways can improve care and reduce healthcare utilisation for complex diseases. However, the adherence to the CP and whether these results lead to a reduction in healthcare costs should be further investigated.

References

(1) van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received a speaker fee from Lilly, Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion, Dr. van Noord reports personal fees from Janssen, Takeda, and Falk, Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

Introduction

Chronic liver disease remains one of the most common causes for hospital admission and is associated with high morbidity and mortality rates. Timely and adequate management within the first 24 hours is crucial for improving clinical outcomes in cases of decompensated cirrhosis. This study aimed to evaluate the impact of implementing a care bundle checklist during the first 24 hours of hospital admission on management and outcomes of decompensated cirrhosis.

Aims & Methods

We developed an adapted care bundle (based on the BSG/BASL care bundle, AASLD quality measures proposal, Baveno VII consensus, and EASL guidelines) and compared two patient groups from two Portuguese hospital centers: Group-A (retrospective, pre-care bundle implementation) and Group-B (prospective, post-care bundle implementation).

Results

A total of 224 patients (Group-A: 148; Group-B: 76) were included. More than one decompensation was observed in 118 patients (52.7%), and 69 patients (30.8%) were experiencing their index hospitalization for liver decompensation. Regarding etiology, alcoholic liver disease was the most common (n=200; 89.3%). The groups were similar in terms of gender, age, length of hospital stay, and Child-Pugh and MELD-Na scores at admission. The most common decompensations were gastrointestinal bleeding (n=91; 40.6%), ascites (n=75; 33.5%), and hepatic encephalopathy (n=72; 32.1%). Group B was more likely to present with multiple decompensations at admission and exhibited significantly higher rates of acute kidney injury, hepatocellular carcinoma, acute-on-chronic liver failure, and portal vein thrombosis (p<0.05). Following care bundle implementation, we found significant improvements in patient care. At admission, patients were significantly more likely to undergo urine and blood cultures, chest X-ray, and abdominal ultrasound (p<0.05), receive diagnostic paracentesis (p<0.05), and have an accurate alcohol history documented (p=0.04). During admission, Group-B was significantly more likely to be prescribed lactulose for encephalopathy prophylaxis, vasopressor therapy for gastrointestinal bleeding, and venous thromboembolism prophylaxis, as well as undergo nutritional assessment (p<0.05). While in-hospital mortality rates were similar (4.7% vs. 5.3%; p=1), 6-week mortality rates (8.8% vs. 3.9%; p=0.01) and 3-month readmission rates (31.1% vs. 15.8%; p=0.02) were significantly lower in the post-intervention cohort.

Conclusion

The implementation of a standardized care bundle was associated with higher rates of appropriate investigation and treatment within the first 24 hours of hospital admission and improved patient outcomes, reducing 6-week mortality and 3-month readmission rates.

Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.