Abstracts

Rationale: Over 30% of patients with epilepsy experience uncontrolled seizures, 85% of admissions for epilepsy arise via the emergency department. The cost to the NHS was over 1.5 billion pounds in 2004. Almost half of those presenting to ED are discharged within 48 hours, 50% without follow up from the epilepsy team or adequate safety guidance1. 15% re-present within 6 months2.Birmingham is the second largest city in the UK; its Queen Elizabeth Hospital (QEBH) serves a population of over a million in the immediate vicinity and over 3 million in the wider West Midlands. The QEBH has a single hospital-based epilepsy specialist nurse (ESN). The need for improvement in acute epilepsy care delivery has been recognised, both at a regional and national level1.1Dixon PA et al. National Audit of Seizure management in Hospitals (NASH): results of the national audit of adult epilepsy in the UK. BMJ 2015 Mar 31;5(3)2Risdale L et al. Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase. Health Service and Delivery Research 2013 No 1.9  Methods: An ESN covering the emergency department and the acute medical unit was employed in March 2019 on a part time pilot basis - three days per week on an NHS band 7 contract ( £25k p.a.).  Results: In the three months pre-pilot, 5 out of 68 (7.3%) patients presenting with first seizure were assessed by an epilepsy specialist within two weeks of admission- the current National Institute for Health and Care Excellence guidance3. The remainder were assessed after a delay of four to eight weeks following admission. 55% were discharged from the acute medical unit. 16% of patients re-presented within three months of admission. In the three months following commencement of the ED nurse, 70 patients were assessed (3.4 per day). 68 (97.1%) were assessed on day 1 of admission, 70% were discharged within 48 hours. All were given safety and lifestyle guidance. All were offered follow up with the epilepsy team. Thus far, none has re-presented.Unexpectedly, the misdiagnosis rate for seizures by ED clinicians was over 40%. The commonest scenario was non epileptic attack disorder treated as epilepsy - over 20%.3Royal College of Physicians (London). The Epilepsies: The Diagnosis and Management of the Epilepsies in Adults and Children in Primary and Secondary Care: Pharmacological Update of Clinical Guideline 20. National Clinical Guideline Centre (UK). NICE clinical guidelines no 137.  Conclusions: The value of an epilepsy nurse covering ED and the acute medical unit is being demonstrated, both in terms of clinical safety (including diagnostic accuracy) and cost efficiency.Subjectively, ED clinicians reported on the increased confidence that an epilepsy nurse gave them, especially in understanding the difference between non-epileptic and epileptic attacks and appreciating the potential role of treatment following a first seizure. Patients reported increased confidence in managing seizures following early specialist input.  Funding: No funding