Standardizing steroid protocols for newly diagnosed inflammatory bowel disease patients: A quality improvement initiative

ObjectivesSystemic steroids can be used for induction of inflammatory bowel disease (IBD), but are not recommended as long-term therapy. Steroid weaning requires rigorous monitoring of symptoms, which may be cumbersome and lead to missed opportunities. We aim to describe our local quality improvement (QI) initiative to improve and standardize the steroid weaning process.MethodsAfter identifying drivers of steroid weaning, a protocol was developed and implemented for newly diagnosed IBD patients started on steroids and subsequently initiated on anti-TNF-alpha therapy. Interventions included development of a tapering schedule, and standardizing communication with patients and evaluation of symptoms. The primary aim was to increase the percent of patients called on a weekly basis by 20%; secondary aims were to decrease the median steroid days by 25% and to increase the number of our patients weaned off steroids at 8 weeks from 35% to 75% by 1 year after the initiative.ResultsThe median percent of patients called on a weekly basis to assess clinical symptoms and to wean steroids increased to 80% after 1 year. The median number of systemic corticosteroid days decreased from 67.5 to 50.5 days post-protocol implementation with 61.1% patients weaned off by 8 weeks from discharge. Zero patients were admitted for flares with the protocol implementation.ConclusionOur experience illustrates that QI methodology can be used successfully to improve and standardize the steroid weaning process, leading to shortened steroid duration and without increased flares and hospitalizations. What is Known Systemic steroids can be used to induce remission in pediatric IBD patients but should not be used for long term therapy due to abundance of adverse effects. Steroids should be weaned with initiation of long term therapy for pediatric patients with IBD.What is New Standardization of steroid titration protocols through QI methodology prevented missed opportunities for weaning and unnecessary prolongation of steroid duration. Utilization of electronic medical record improves steroid tapering in pediatric IBD.