Abstracts

Rationale: During a time of rising scrutiny by payor sources, health care teams must develop innovative, cost-effective methods of providing needed medical care to vulnerable populations. The team at Nationwide Children’s Hospital developed the Established Urgent Epilepsy Clinic (EUEC) as one intervention to combat medically unnecessary unplanned healthcare vistis. Within that intervention, patients are scheduled to be seen by a Neurology Nurse Practitioner and Epilepsy Social Worker team within days of referral. Previous evaluations of the project have proven its effectiveness overall. Significant cultural and communication barriers exist in caring for those with a preferred language other than English; therefore we must ensure we are appropriately meeting the needs of a growing population of patients.Methods: Patients with a preferred language other than English were identified using electronic medical record data collection searches for interpreter use as well as chart review of patients seen in the EUEC from third quarter 2013 through 2014. Nine patients’ caregivers were found to utilize medical interpreter services while two patients’ caregivers refuse medical interpreter services but speak a language other than English in their homes. The languages included can be found in Table 1. A retrospective chart review of the patients with a preferred language other than English was conducted to determine the number of emergency department visits and unplanned hospital admissions with seizures, convulsions, or status epilepticus listed as the visit reason for the three months preceding and three months following the EUEC appointment. Referral criteria for the EUEC can be found in Table 2.Results: Of the ninety-nine patients seen in the EUEC from third quarter 2013 through 2014, 11 % (n=11) have a preferred language other than English compared to 3.46% (n=349) of patients seen in Neurology with a primary or secondary diagnosis of seizure or epilepsy. Greater than half of the patients demonstrated a reduction in unplanned healthcare utilization. Only one patient demonstrated an increase in unplanned healthcare utilization.Conclusions: In an assessment of the use of an emergency department diversion initiative called the Established Urgent Epilepsy Clinic, we found a decrease in unplanned healthcare utilization costs among those with a preferred language other than English. With nearly three times the number of patients with a preferred language other than English when compared to Neurology patients with a preferred language other than English at the same institution, there is a distinct over-representation in referrals to the EUEC. Additionally, greater than half of the patients with a preferred language other than English have shown a decrease in unplanned healthcare utilization following the EUEC visit. The initial evidence suggests that the EUEC is meeting the unique needs of patients with a preferred language other than English resulting in fewer healthcare dollars spent in unplanned healthcare utilization.