Published online Feb 6, 2017. doi: 10.4292/wjgpt.v8.i1.81
Peer-review started: July 12, 2016
First decision: September 12, 2016
Revised: September 27, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: February 6, 2017
Processing time: 198 Days and 12.8 Hours
To assess the development and implementation of the Integrated Rapid Assessment and Treatment (IRAT) pathway for the management of patients with fecal incontinence and measure its impact on patients’ care.
Patients referred to the colorectal unit in our hospital for the management of faecal incontinence were randomised to either the Standard Care pathway or the newly developed IRAT pathway in this feasibility study. The IRAT pathway is designed to provide a seamless multidisciplinary care to patients with faecal incontinence in a timely fashion. On the other hand, patients in the Standard Pathway were managed in the general colorectal clinic. Percentage improvements in St. Marks Incontinence Score, Cleveland Clinic Incontinence Score and Rockwood Faecal Incontinence Quality of Life Scale after completion of treatment in both groups were the primary outcome measures. Secondary endpoints were the time required to complete the management and patients’ satisfaction score. χ2, Mann-Whitney-U and Kendall tau-c correlation coefficient tests were used for comparison of outcomes of the two study groups. A P value of 0.05 or less was considered significant.
Thirty-nine patients, 34 females, consented to participate. Thirty-one (79.5%) patients completed the final assessment and were included in the outcome analysis. There was no significant difference in the quality of life scales and incontinence scores. Patients in the IRAT pathway were more satisfied with the time required to complete management (P = 0.033) and had stronger agreement that all aspects of their problem were covered (P = 0.006).
Despite of the lack of significant difference in outcome measures, the new pathway has positively influenced patient’s mindset, which was reflected in a higher satisfaction score.
Core tip: Critical pathways and process mapping methodology was used in industry since the 1950s and in medical field since the 1980s. This randomised trial describes the implementation of the Integrated Rapid Assessment and Treatment pathway, that was designed to provide a seamless multidisciplinary care to patients with faecal incontinence in a timely fashion, and compares it to the current standard of care. Although, there was no significant difference in quality-of-life and incontinence scores after completion of management, the new pathway positively influenced patient’s mindset, as shown by the higher satisfaction scores. This is likely to reflect the structured support and thorough education patients in this group received.