INTRODUCTION: Inflammatory bowel diseases are associated with unpredictable disease exacerbation and need for urgent care. We aimed to assess long-term sustained improvement in emergency department utilization after completion of a multicenter quality improvement (QI) initiative. METHODS: After the QI initiative, we developed an "urgent care toolkit" for sites to implement. We measured patient-reported and provider-reported outcomes at clinical visits. RESULTS: Improvements in emergency department utilization and hospitalization were sustained for over 3 years after completion of the initiative. DISCUSSION: Efforts to sustain improvements after a QI initiative can result in long-term improvement in patient outcomes.