The iron need: utilisation of intravenous iron in an east London ambulatory care unit to prevent inpatient admission

Abstract

Introduction: Iron deficiency anaemia (IDA) is a major cause of morbidity worldwide, affecting 2-5% of adult men and post-menopausal women in the developed world alone.1 Guidelines on management focus on identification of underlying pathology, and replenishment of iron stores through oral or intravenous (IV) supplementation. Blood transfusions are usually reserved for patients with haemodynamic compromise.1 IDA is an ambulatory care-sensitive condition (ACSC) and should ideally be managed in outpatient settings.2 However, it currently accounts for more preventable admissions compared with asthma or diabetes mellitus.3 Material(s) and Method(s): This project assessed the provision of IV iron in an east London ambulatory care unit (ACU) over an 18-month period, determining whether the service was being utilised effectively for the correct cohort and to prevent avoidable admissions. Data were collected retrospectively at four discrete time points, with a consultant vetting process of referrals introduced between the first two time points, and presentation at local departmental meetings between the second and third time points. Results and Discussion: Reflecting the diverse local population, the largest ethnic group treated was Bangladeshi (41.4%),4 a more socially and economically disadvantaged community who are at greater risk of iron deficiency.5 Over the four time points, an increase in the use of IV iron for those with clear contra-indications or documented intolerance to oral therapy was demonstrated (6.3%, 8.3%, 29.6% and 53.6%, respectively). Furthermore, there was an increase in referrals accepted directly from the emergency department (ED), urgent treatment centre (UTC) and acute medical take over the four time points (18.5%, 37.5%, 40.7% and 35.7%, respectively). These patients were able to be discharged with an acute care unit (ACU) appointment, with only 2.7% of all patients then admitted from ACU. This is especially significant in areas with high ethnic minority populations, who remain at greater risk of inpatient complications.6 Conclusion(s): Provision of a robust IV iron service is vital in preventing otherwise avoidable hospital admissions. Future improvements may include the creation of a dedicated IV iron unit, to further expand capacity and support in keeping patients out of hospital.Copyright © 2025