Abstracts

Rationale: Video EEG is undertaken to correlate the clinical features of a patient’s events synchronized with electrographic changes and provide valuable information regarding seizure semiology, characterization of epilepsy syndrome, localization of seizure onset zone and to guide patient management. The procedure requires coordination between the patient and their family and the hospital and has significant financial costs. Patients are occasionally taken off their medication to provoke seizures and increase the risk to patient safety. It is therefore imperative that all the patient events are completely captured on video and EEG. Patients at UK are monitored under four different settings including Adult EMU, Pediatric EMU and Brain Telemetry monitoring in adult and pediatric hospitals on the floor and ICU using portable machines. Based on our previous study, we determined a significant difference in the number of events recorded between adult and pediatric population. One of the reasons for this difference was determined to be absence of a nursing technician who could adjust the position of the camera. With this study, our aim was to assess the improvement after our intervention – the introduction of a technician; and to identify other factors which could contribute to this difference.Methods: We retrospectively reviewed the daily video recordings of all patients undergoing video EEG monitoring during a 2 week randomly selected period, from March 10th, 2014 to March 23rd, 2014 and compared it to another 2 week period, from May 4th to May 17th, 2015 after our “intervention” in pediatric EMU. The EEG recordings were reviewed for patient events/ push button events, as observed by the patients themselves, their accompanying family members or the nursing staff. The video recordings of these events were then reviewed to determine if the patient was ""on camera"" during the episode and if meaningful information was obtained. We compared the four cohorts as described above.Results: During the pre-intervention study period, all of the events (100%) in the adult EMU were determined to be “on camera” while in the pediatric EMU only 89% of the events were “on camera” and 11% episodes could not be recorded as the patient was ""off camera"". After the intervention, 100% of the events in pediatric EMU were on camera. Similarly, 100% of events on adult floor were “on camera” during both phases of our study while on pediatric floor, 25% of events were “off camera” during the first phase and 17% were “off camera” in the second phase. 100% of events in adult and pediatric ICU were “on camera” during both phases.Conclusions: Based on the results of this study, we conclude that our intervention of having a nursing technician made significant improvement in the number of events caught “on camera” in pediatric EMU. Since, it is difficult to be able to control the camera remotely for portable units being used on adult and pediatric floor, we believe that educating the family of pediatric patients and nursing staff may be beneficial in capturing maximum number of events.