Abstracts

Rationale: The majority of first episodes of seizures in children present to the emergency department. When recurrent episodes occur, children are often brought to the emergency department again. Use of emergency resources is very costly, time consuming and stressful for the family and could be dealt with effectively via a different mode of health care delivery. Timely access to a nurse practitioner specializing in epilepsy following the first emergency room (ER) visit could prevent further ER visits. This would allow for education; a contact practitioner with specialization in managing patients with epilepsy; decrease the economic burden of unnecessary ER visits and allow more efficient care of children who do need ER servicesMethods: A six month pilot program was implemented at the Stollery Childrens Hospital in Edmonton, Alberta Canada from October 2010 to April 2010. Children presenting to the emergency department with new onset seizures, febrile seizures or new onset of epilepsy are booked into be seen by the Nurse Practitioner within 7 to 10 days of presenting to emergency. Families are provided with education and written information on seizure first aid and seizure precautions and date and time of appointment with Nurse Practitioner upon discharge from the ER. Results: Forty six were seen in the Pediatric Emergency Seizure Clinic from October 18 2010 to April 18 2011. Clinics were held every Monday from 0800 to 1200, with one hour consults for each patient. Of the 46 patients seen 15 had Simple Febrile Seizures, 7 were had Epilepsy that required treatment with medication, 7 had non epileptic events such as migraine, breathholding, syncope or sleep disturbance, 6 had a first episode of a single seizure, 2 patients had complex partial seizure and 9 patients did not show for their appointments in clinic (2 were admitted to hospital for their seizures at the time). Patients were seen on average within 10 days of the ER visit, a range of 2 to 23 days. Six patients had presented previously to the emergency with seizures, 3 patients presented to emergency following the clinic appointment, one patient presenting in status. The majority of patients were from the local area, 6 were from out of town therefore requiring travel to attend the Seizure Clinic appointment. Conclusions: The Pediatric Emergency Seizure Clinic is continuing weekly as response from ER physicians, Neurology and families has been positive. Benefits of the program can already be demonstrated. Typically patients will wait 6 to 9 months to be seen in outpatient consultation by Pediatric Neurology. Children now presenting to the Emergency can be see on average in 10 days. Telehealth may be an option to offer out of town patients to save time and expenses. The Nurse Practitioner is an appropriate healthcare provider to utilize for this clinic allowing treatment to be initiated earlier when needed and education to alleviate family anxiety and prevent further ER visits. Continued gathering of data will allow for demonstration of economic benefit of the program over time.