1
|
O'Dwyer R, Leppik IE, Eads P, Long Y, Birnbaum AK. Overview of acute seizure management in US nursing homes. Epilepsy Behav 2024; 158:109913. [PMID: 38959744 DOI: 10.1016/j.yebeh.2024.109913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Residents in NH are more likely to be diagnosed with epilepsy or seizures, which are associated with higher mortality and complicate care. This setting provides unique challenges in the treatment of seizures however, little is known about current management practices in NH. Most studies in the literature concentrate on the use of antiseizure medications (ASMs) but little is known about the management of the acute seizure and clinical guidance is needed to ensure the safety of this vulnerable population. The objective of this study was to survey current practices, identifying knowledge deficits and inform future educational endeavors, including acute seizure action plans (ASAPs). METHODS A survey was developed pertaining to a broad spectrum of clinical aspects in the management of acute seizures in NH, distinguishing first time seizures from those in the setting of a known seizure disorder. It was sent to NH medical directors throughout the US and data was gathered from those who had at least one new case of new onset/epilepsy in the last 3 years. RESULTS Ninety-one NH directors responded with 52 % having a seizure protocol. Nurses are responsible in the majority of cases for protocol activation. Regardless of the patient's seizure history, rescue medications are given in the majority of cases, oral benzodiazepines, followed by intravenous and then rectal benzodiazepines. Newer intranasal and intramuscular formulations of benzodiazepines were less frequently prescribed. The most commonly prescribed ASM is levetiracetam, followed by lamotrigine, valproic acid and phenytoin. Staff training and in-service education occur infrequently. Respondents thought no-cost seizure education would be highly beneficial. CONCLUSIONS AND IMPLICATIONS Only approximately half of NH have protocols for the acute management of seizures. Rescue medications are given regardless of seizure history and often older ASMs are used for long-term management. Our study highlights areas of knowledge deficits and treatment areas for improvement, identifying the need and potential for ASAPs in NHs.
Collapse
Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, USA.
| | - Ilo E Leppik
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Pam Eads
- UCB Pharmaceuticals, Smyrna, GA, USA
| | - Yuhan Long
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angela K Birnbaum
- Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
2
|
Noble AJ, Morris B, Dixon P, Mathieson A, Ridsdale L, Morgan M, Dickson J, Goodacre S, Jackson M, Hughes D, Marson A, Holmes E. Service users' preferences and feasibility - which alternative care pathway for adult ambulance users achieves the optimal balance? Workshops for the COLLABORATE project. Seizure 2024; 118:17-27. [PMID: 38613878 DOI: 10.1016/j.seizure.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Adults presenting to the ambulance service for diagnosed epilepsy are often transported to emergency departments (EDs) despite no clinical need. An alternative care pathway (CP) could allow paramedics to divert them from ED and instigate ambulatory care improvements. To identify the most promising CP configuration for subsequent testing, the COLLABORATE project surveyed people with epilepsy and family/friends who had recently used the English ambulance service to elicit preferences for 288 CP configurations for different seizures. This allowed CPs to be ranked according to alignment with service users' preferences. However, as well as being acceptable to users, a CP must be feasible. We thus engaged with paramedics, epilepsy specialists and commissioners to identify the optimal configuration. METHODS Three Knowledge Exchange workshops completed. Participants considered COLLABORATE's evidence on service users' preferences for the different configurations. Nominal group techniques elicited views on the feasibility of users' preferences according to APEASE criteria. Workshop groups specified the configuration/s considered optimum. Qualitative data was analysed thematically. Utility to users of the specified CP configurations estimated using the COLLABORATE preference survey data. RESULTS Twenty-seven participants found service users' preferences broadly feasible and outlined delivery recommendations. They identified enough commonality in preferences for different seizures to propose a single CP. Its configuration comprised: 1) patients staying where they were; 2) paramedics having access to medical records; 3) care episodes lasting <6 h; 4) paramedics receiving specialist advice on the day; 5) patient's GP being notified; and 6) a follow-up appointment being arranged with an epilepsy specialist. Preference data indicated higher utility for this configuration compared to current care. DISCUSSION Stakeholders are of the view that the CP configuration favoured by service users could be NHS feasible. It should be developed and evaluated.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Beth Morris
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| |
Collapse
|
3
|
Holmes E, Dixon P, Mathieson A, Ridsdale L, Morgan M, McKinlay A, Dickson J, Goodacre S, Jackson M, Foster D, Hardman K, Bell S, Marson A, Hughes D, Noble AJ. Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project. Seizure 2024; 118:28-37. [PMID: 38615478 DOI: 10.1016/j.seizure.2024.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. METHODS Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. RESULTS People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). DISCUSSION Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required.
Collapse
Affiliation(s)
- Emily Holmes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Pete Dixon
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Amy Mathieson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neuroscience, King's College London, London, UK; Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Jon Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | | | | | - Steve Bell
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics & Medicines Evaluation, North Wales Medical School, Bangor University, UK; Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| |
Collapse
|
4
|
Noble AJ, Morris B, Bonnett LJ, Reuber M, Mason S, Wright J, Pilbery R, Bell F, Shillito T, Marson AG, Dickson JM. 'Knowledge exchange' workshops to optimise development of a risk prediction tool to assist conveyance decisions for suspected seizures - Part of the Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project. Epilepsy Behav 2024; 151:109611. [PMID: 38199055 DOI: 10.1016/j.yebeh.2023.109611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Suspected seizures present challenges for ambulance services, with paramedics reporting uncertainty over whether or not to convey individuals to emergency departments. The Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project aims to address this by developing a risk assessment tool utilizing structured patient care record and dispatch data. It proposes a tool that would provide estimates of an individual's likelihood of death and/or recontact with emergency care within 3 days if conveyed compared to not conveyed, and the likelihood of an 'avoidable attendance' occurring if conveyed. Knowledge Exchange workshops engaged stakeholders to resolve key design uncertainties before model derivation. METHOD Six workshops involved 26 service users and their significant others (epilepsy or nonepileptic attack disorder), and 25 urgent and emergency care clinicians from different English ambulance regions. Utilizing Nominal Group Techniques, participants shared views of the proposed tool, benefits and concerns, suggested predictors, critiqued outcome measures, and expressed functionality preferences. Data were analysed using Hamilton's Rapid Analysis. RESULTS Stakeholders supported tool development, proposing 10 structured variables for predictive testing. Emphasis was placed on the tool supporting, not dictating, care decisions. Participants highlighted some reasons why RADOSS might struggle to derive a predictive model based on structured data alone and suggested some non-structured variables for future testing. Feedback on prediction timeframes for service recontact was received, along with advice on amending the 'avoidable attendance' definition to prevent the tool's predictions being undermined by potential overuse of certain investigations in hospital. CONCLUSION Collaborative stakeholder engagement provided crucial insights that can guide RADOSS to develop a user-aligned, optimized tool.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Beth Morris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Laura J Bonnett
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Department of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Suzanne Mason
- Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | | | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | | | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Jon M Dickson
- Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| |
Collapse
|
5
|
Mbizvo GK, Schnier C, Simpson CR, Duncan SE, Chin RFM. Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death. Brain 2023; 146:2418-2430. [PMID: 36477471 PMCID: PMC10232261 DOI: 10.1093/brain/awac463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/29/2022] [Accepted: 11/26/2022] [Indexed: 02/17/2024] Open
Abstract
This study aimed to develop a risk prediction model for epilepsy-related death in adults. In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009 and 2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index-the Scottish Epilepsy Deaths Study Score. Odds ratios were estimated with 95% confidence intervals (CIs). Here, 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency attendance (odds ratio 5.1, 95% CI 3.2-8.3), living in deprived areas (odds ratio 2.5, 95% CI 1.6-4.0), developmental epilepsy (odds ratio 3.1, 95% CI 1.7-5.7), raised Charlson Comorbidity Index score (odds ratio 2.5, 95% CI 1.2-5.2), alcohol abuse (odds ratio 4.4, 95% CI 2.2-9.2), absent recent neurology review (odds ratio 3.8, 95% CI 2.4-6.1) and generalized epilepsy (odds ratio 1.9, 95% CI 1.2-3.0). Scottish Epilepsy Deaths Study Score model variables were derived from the first four listed before, with Charlson Comorbidity Index ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points and recent epilepsy-related accident and emergency attendance given 3 points. Compared to having a Scottish Epilepsy Deaths Study Score of 0, those with a Scottish Epilepsy Deaths Study Score of 1 remained low risk, with odds ratio 1.6 (95% CI 0.5-4.8). Those with a Scottish Epilepsy Deaths Study Score of 2-3 had moderate risk, with odds ratio 2.8 (95% CI 1.3-6.2). Those with a Scottish Epilepsy Deaths Study Score of 4-5 and 6-8 were high risk, with odds ratio 14.4 (95% CI 5.9-35.2) and 24.0 (95% CI 8.1-71.2), respectively. The Scottish Epilepsy Deaths Study Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation.
Collapse
Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
| | | | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Susan E Duncan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh EH16 4SA, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| |
Collapse
|
6
|
Noble AJ, Mason SM, Bonnett LJ, Reuber M, Wright J, Pilbery R, Jacques RM, Simpson RM, Campbell R, Fuller A, Marson AG, Dickson JM. Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)-protocol for the mixed-methods observational RADOSS project. BMJ Open 2022; 12:e069156. [PMID: 36375988 PMCID: PMC9668054 DOI: 10.1136/bmjopen-2022-069156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ambulances services are asked to further reduce avoidable conveyances to emergency departments (EDs). Risk of Adverse Outcomes after a Suspected Seizure seeks to support this by: (1) clarifying the risks of conveyance and non-conveyance, and (2) developing a risk prediction tool for clinicians to use 'on scene' to estimate the benefits an individual would receive if conveyed to ED and risks if not. METHODS AND ANALYSIS Mixed-methods, multi-work package (WP) project. For WP1 and WP2 we shall use an existing linked data set that tracks urgent and emergency care (UEC) use of persons served by one English regional ambulance service. Risk tools are specific to clinical scenarios. We shall use suspected seizures in adults as an exemplar.WP1: Form a cohort of patients cared for a seizure by the service during 2019/2020. It, and nested Knowledge Exchange workshops with clinicians and service users, will allow us to: determine the proportions following conveyance and non-conveyance that die and/or recontact UEC system within 3 (/30) days; quantify the proportion of conveyed incidents resulting in 'avoidable ED attendances' (AA); optimise risk tool development; and develop statistical models that, using information available 'on scene', predict the risk of death/recontact with the UEC system within 3 (/30) days and the likelihood of an attendance at ED resulting in an AA.WP2: Form a cohort of patients cared for a seizure during 2021/2022 to 'temporally' validate the WP1 predictive models.WP3: Complete the 'next steps' workshops with stakeholders. Using nominal group techniques, finalise plans to develop the risk tool for clinical use and its evaluation. ETHICS AND DISSEMINATION WP1a and WP2 will be conducted under database ethical approval (IRAS 307353) and Confidentiality Advisory Group (22/CAG/0019) approval. WP1b and WP3 have approval from the University of Liverpool Central Research Ethics Committee (11450). We shall engage in proactive dissemination and knowledge mobilisation to share findings with stakeholders and maximise evidence usage.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Suzanne M Mason
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Laura J Bonnett
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | | | - Richard Pilbery
- Research and Development Department, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Richard M Jacques
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca M Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Richard Campbell
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Anthony Guy Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Jon Mark Dickson
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| |
Collapse
|
7
|
Chuah A, Ding K, Morgado A, McCreary M, Zuberi F, Agostini M, Doyle A. Effects of psychiatric comorbidities in persons with epilepsy on recurrent emergency department visits. Epilepsy Behav 2022; 136:108909. [PMID: 36152383 DOI: 10.1016/j.yebeh.2022.108909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coexisting mental health disorders in persons with epilepsy present as substantial burdens to patients and healthcare systems. STUDY DESIGN AND METHODS In this retrospective study, we reviewed 160 patients presenting to a safety net hospital Emergency Department (ED) with seizures to investigate whether differences in clinical workup, follow-ups, and ED visit recurrence existed between epilepsy patients with epilepsy with and without a coexisting psychiatric disorder. RESULTS Patients with epilepsy with a psychiatric comorbidity had more subsequent ED visits (45 % vs 26 %, p = 0.01) and fewer outpatient follow-up opportunities (74 % vs 87 %, p = 0.042) compared to patients with epilepsy without psychiatric comorbidities, highlighting a healthcare gap that needs to be addressed. INTERPRETATION Our findings suggest a need for ED providers to shift their clinical practice in favor of offering more outpatient follow-up opportunities, to ensure long-term management of seizures in patients with epilepsy with comorbid psychiatric disorders.
Collapse
Affiliation(s)
- Ashleigh Chuah
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Kan Ding
- UT Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Anika Morgado
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Morgan McCreary
- UT Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Fatima Zuberi
- UT Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Mark Agostini
- UT Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| | - Alexander Doyle
- UT Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
| |
Collapse
|
8
|
Patel AD, Debs A, Terry D, Parker W, Burch M, Luciano D, Patton L, Brubaker J, Chrisman J, Moellman K, Herbst J, Cohen DM. Decreasing Emergency Department Visits for Children With Epilepsy. Neurol Clin Pract 2021; 11:413-419. [PMID: 34840868 DOI: 10.1212/cpj.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives Epilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy. Methods In 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible. Our aim statement was to decrease the number of ED visits, per 1000 established patients with epilepsy, from 13.03 to 11.6, by December 2019 and sustain for 1 year. Results We successfully decreased ED visits for seizure-related care in patients with epilepsy from 13.03% to 10.2% per 1,000 patients, which resulted in a centerline shift. Discussion Using QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.
Collapse
Affiliation(s)
- Anup D Patel
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Andrea Debs
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debbie Terry
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - William Parker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Mary Burch
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Debra Luciano
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Lauren Patton
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Jena Brubaker
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Julie Chrisman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Kathy Moellman
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - James Herbst
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| | - Daniel M Cohen
- Division of Neurology (ADP, AD, DT, WP, MB, LP, JB, JC, KM), Center of Clinical Excellence (ADP), Department of Pharmacy (JH), and Division of Emergency Medicine (DMC), Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
9
|
McKinlay A, Morgan M, Noble A, Ridsdale L. Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study. Seizure 2020; 80:56-62. [PMID: 32540637 PMCID: PMC7443693 DOI: 10.1016/j.seizure.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Emergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. METHODS We conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. RESULTS Participants' choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. CONCLUSION Improving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.
Collapse
Affiliation(s)
- Alison McKinlay
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| | - Myfanwy Morgan
- King's College London, Institute of Pharmaceutical Science, London, UK.
| | - Adam Noble
- University of Liverpool, Department of Health Services Research, UK.
| | - Leone Ridsdale
- King's College London, Department of Basic and Clinical Neuroscience, London, UK.
| |
Collapse
|
10
|
Mathieson A, Marson AG, Jackson M, Ridsdale L, Goodacre S, Dickson JM, Noble AJ. Clinically unnecessary and avoidable emergency health service use for epilepsy: A survey of what English services are doing to reduce it. Seizure 2020; 76:156-160. [PMID: 32092677 DOI: 10.1016/j.seizure.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Epilepsy is associated with costly unplanned health service use. The UK's National Audits of Seizure Management in Hospital found use was often clinically unnecessary, avoidable and typically led to little benefit for epilepsy management. We systematically identified how services have responded to reduce such use. METHODS We invited England's ambulance services, neuroscience and neurology centres and a random sample of Emergency Departments (EDs) to complete a survey. It asked what innovations they (or services they worked with) had made in the past 5 years or were making, the priority afforded to them, user involvement, what comprised usual practice, and barriers to change. RESULTS 72/87 of invited (82.8 %) services responded. EDs ascribed less priority to reducing emergency hospital use for epilepsy and convulsions, than other service types. Overall, 60 % of services reported a change(s) and/or were planning one. Neurology/neuroscience sites (93.8 %) were most likely to report change; EDs (15.4 %) least likely. Eleven types of change were identified; 5 sought to promote proactive epilepsy care and avert the need for emergency care; 3 focused on the care received from emergency services; and 3 focused on follow-up care ED attendees received. Most were for those with established, rather than new epilepsy and targeted known limitations to current care provision. CONCLUSION Reducing emergency hospital use by PWE is a high priority for most health services in England and a number of new services have been developed. However, they have not been consistently implemented and innovation is lacking in some areas of care.
Collapse
Affiliation(s)
- Amy Mathieson
- Department of Health Services Research, University of Liverpool, UK.
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool. UK
| | - Mike Jackson
- North West Ambulance Service NHS Trust, Bolton, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, UK
| | - Jon M Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, UK
| | - Adam J Noble
- Department of Health Services Research, University of Liverpool, UK
| |
Collapse
|