Multidisciplinary clinician perspectives on reducing avoidable inflammatory bowel disease admissions: A mixed methods study

ObjectivesUnplanned hospital admissions are common for people with inflammatory bowel disease (IBD). While clinical predictors of admission are well-documented, research is limited exploring the healthcare delivery factors and system inequalities that contribute to these events. DesignAn online survey, distributed via United Kingdom (UK) and European professional networks, and semi-structured interviews explored clinicians views of admission types, causes and barriers to preventing admissions. Clinicians ranked causes and barriers to preventing admissions, analysed by descriptive statistics and Friedman and Wilcoxon rank tests. We used framework analysis, guided by Candidacy Theory, to analyse qualitative data across data types to explore issues of healthcare access. Results80 clinicians completed the survey, 13 were interviewed. For all unplanned IBD admissions, an unpreventable disease progression was ranked the highest cause (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). Qualitative interviews elaborated on avoidable unplanned admissions through: (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 across the study related to patient navigation of services, organisational barriers, provider decision-making and structural issues that impede access to care. ConclusionsMost avoidable admissions were perceived 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. What is already known on this topic Unplanned hospital admissions are a common and costly outcome for people living with inflammatory bowel disease (IBD). While clinical predictors of admission are well-documented, there is limited research exploring the healthcare delivery factors and system inequalities that contribute to these events. What this study adds This study presents a clinician-led definition of avoidable IBD admissions as those resulting from missed outpatient opportunities, specialist delays, and system constraints. While disease progression was the perceived primary cause, IBD admissions are also perceived to be driven by modifiable systemic failures, specifically waiting times, resource gaps, and navigation hurdles influenced by social determinants. How this study might affect research, practice or policy The findings advocate for and inform prospective service development interventions for improved rapid-access flare pathways and the strengthening of patient education to improve service navigation. There is a clear need for significant investment in workforce and infrastructure, specifically regarding infusion capacity and specialist staffing, to prevent missed care escalation.