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. 2012:2012:273175.
doi: 10.1155/2012/273175. Epub 2012 May 29.

A seizure care pathway in the emergency department: preliminary quality and safety improvements

Parameswaran M Iyer  1 , Patricia H McNamara, Margaret Fitzgerald, Liam Smyth, Christopher Dardis, Tania Jawad, Patrick K Plunkett, Colin P Doherty
Affiliations

A seizure care pathway in the emergency department: preliminary quality and safety improvements

Parameswaran M Iyer et al. Epilepsy Res Treat. 2012.

Abstract

Aim. To evaluate the utility of a seizure care pathway for seizure presentations to the emergency department (ED) in order to safely avoid unnecessary admission and to provide early diagnostic and therapeutic guidance and minimize length of stay in those admitted. Methods. 3 studies were conducted, 2 baseline audits and a 12-month intervention study and prospective data was collected over a 12-month period (Nov 2008-09). Results. Use of the Pathway resulted in a reduction in the number of epilepsy related admissions from 341 in 2004 to 276 in 2009 (P = 0.0006); a reduction in the median length of stay of those admittedfrom 4-5 days in the baseline audits to 2 days in the intervention study (P ≤ 0.001); an improvement in time to diagnostic investigations such as CT brain, MRI brain and Electroencephalography (P ≤ 0.001, P ≤ 0.048, P ≤ 0.001); a reduction in readmission rates from 45.1% to 8.9% (P ≤ 0.001); and an improvement in follow-up times from a median of 16 weeks to 5 weeks (P < 0.001). From a safety perspective there were no deaths in the early discharged group after 12 months follow-up. Conclusion. The burden of seizure related admissions through the ED can be improved in a safe and effective manner by the provision of a seizure care pathway.

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Figures

Figure 1
Figure 1
The Seizure Care Pathway used in the Intervention Study from November 2008.
Figure 2
Figure 2
Median length of stay is shown in days for each of the study periods in Figure 2.
Figure 3
Figure 3
The median length of time to CT brain, EEG and MRI brain for each of the study periods.
Figure 4
Figure 4
The median time to follow-up in weeks for the baseline audit in 2004 and the intervention study in 2008-2009.
Figure 5
Figure 5
The rate of representations of patients with seizures to the Emergency Department in 2004 and during the intervention study in 2008-2009.
See this image and copyright information in PMC

References

    1. Shorvon SD. The Treatment of Epilepsy. Oxford, UK: Blackwell; 2005.
    1. Pugliatti M, Beghi E, Forsgren L, Ekman M, Sobocki P. Estimating the cost of epilepsy in Europe: a review with economic modeling. Epilepsia. 2007;48(12):2224–2233. - PubMed
    1. Andlin-Sobocki P, Jonsson B, Wittchen HU, Olesen J. Cost of disorders of the brain in Europe. European Journal of Neurology. 2005;12(supplement 1):1–27. - PubMed
    1. Linehan C, Kerr MP, Walsh PN, et al. Examining the prevalence of epilepsy and delivery of epilepsy care in Ireland. Epilepsia. 2010;51(5):845–852. - PubMed
    1. Dunn MJG, Breen DP, Davenport RJ, Gray AJ. Early management of adults with an uncomplicated first generalised seizure. Emergency Medicine Journal. 2005;22(4):237–242. - PMC - PubMed

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