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. 2020 Apr 14;5(2):255-262.
doi: 10.1002/epi4.12393. eCollection 2020 Jun.

Post-acute symptomatic seizure (PASS) clinic: A continuity of care model for patients impacted by continuous EEG monitoring

Vineet Punia  1 , Pradeep Chandan  1 , Jessica Fesler  1 , Christopher R Newey  1   2   3 , Stephen Hantus  1
Affiliations

Post-acute symptomatic seizure (PASS) clinic: A continuity of care model for patients impacted by continuous EEG monitoring

Vineet Punia et al. Epilepsia Open. .

Abstract

Objective: We present a model for the outpatient care of patients undergoing continuous electroencephalography (cEEG) monitoring during a hospitalization, named the post-acute symptomatic seizure (PASS) clinic. We investigated whether establishing this clinic led to improved access to epileptologist care.

Methods: As part of the PASS clinic initiative, electronic health record (EHR) provides an automated alert to the inpatient care team discharging adults on first time antiepileptic drug (AED) after undergoing cEEG monitoring. The alert explains the rationale and facilitates scheduling for a PASS clinic appointment, three-month after discharge, along with a same-day extended (75 minutes) EEG. We compared the initial epilepsy clinic visits by patients undergoing cEEG in 2017, before ("Pre-PASS" period and cohort) and after ("PASS" period and cohort) the alert went live in the EHR.

Results: Of the 170 patients included, 68 (40%) suffered a seizure during the mean follow-up of 20.9 ± 10 months. AEDs were stopped or reduced in 66 out of 148 (44.6%) patients discharged on AEDs. Pre-PASS cohort included 45 patients compared to 145 patients in the PASS cohort, accounting for 5.8% and 9.9% of patients, respectively, who underwent cEEG during the corresponding periods (odds ratio [OR] = 1.8, 95% CI = 1.26-2.54, P = .001). The two cohorts did not differ in terms of electrographic or clinical seizures. The PASS cohort was significantly more likely to be followed up within 1-6 months of discharge (OR = 4.6, 95% CI = 2.1-10.1, P < .001) and have a pre-clinic EEG (51.2% vs 11.1%; OR = 8.39, 95% CI = 3.1-22.67, P < .001).

Significance: PASS clinic, a unique outpatient transition of care model for managing patients at risk of acute symptomatic seizure led to an almost twofold increase in access to an epileptologist. Future research should address the wide knowledge gap about the best post-hospital discharge management practices for these patients.

Keywords: PASS clinic; acute seizures; antiepileptic drugs; continuous EEG; epilepsy clinic; model of care.

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Conflict of interest statement

None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

FIGURE 1
FIGURE 1
Pictorial representation of PASS clinic protocol for eligible patients from hospitalization to the outpatient visit
FIGURE 2
FIGURE 2
Sample best practice advisory (BPA) alert that fires after a hospital discharge order is placed for an eligible patient
FIGURE 3
FIGURE 3
Distribution of Pre‐PASS and PASS cohort based on the time from hospital discharge to the initial clinic visit
See this image and copyright information in PMC

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