Reducing Hospitalization Related to Seizures in Children: A Quality Improvement Initiative
Ayush Gupta1, Benjamin Cusick2, Rebecca Hart3, Samir Karia1
1Pediatric Neurology, 2School of medicine, 3Pediatric Emergency medicine, University of Louisville
Objective:
To reduce Epilepsy/seizures related admissions by 30% over one year of project application compared to baseline through use of quality improvement approach
To reduce Emergency department visits related to seizures/seizure like episodes
Cost-benefit analysis of epilepsy care clinic in the emergency department to determine long term feasibility
Background:
Seizures are important cause of neurology related ED visits, many of which can be managed on outpatient basis, and help reducing healthcare costs. In the given quality improvement study, we aim to reduce admissions and emergency visits to the hospital using QI methodology.
Design/Methods:
In the first PDSA cycle, patients were triaged into high risk for readmissions while visiting outpatient clinic. The second cycle involved creation of epilepsy hotline and identifying target patients; by providing resources to transport to the clinic, direct access to tell about medication related issues etc. In third PDSA, Access to outpatient EEG and clinic visits was improved by systems approach and improving waitlist. The last cycle targeting ED visits involves creation of urgent epilepsy clinic, with after office hours access to a neurologist in the emergency department.
Results:
In terms of ED visits, no changes in total ED visits were seen when compared to data from previous year. Seizure related admissions have been reduced to 43% compared to 54% (p=0.007) from the matched data prior to implementation of the QI. Routine EEG testing in emergency rooms improved from 6.5 per month before the PDSA to 3.3 per month (p=0.12). Currently, urgent epilepsy care at ED is being set up.
Conclusions:
Systems related approach, targeting patients at risk of visits and improved access can reduce seizure related admissions. Creation of urgent epilepsy care at ED is expected to help further bypass expensive admission visits.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.