Abstracts

Rationale: The waiting time for an Epilepsy or Seizure initial evaluation in our community is 12 weeks. In combination with other barriers to care such as mangaged care and other gatekeeper mechanisms,many utilize the emergency department (ED)as a primary care resource. We sought to develop an open access epilepsy clinic, available to our network of referring physicians, specifically those in our ED and university practices regardless of insurance.Methods: We developed a once a month clinic. The clinic had a fixed time. Appointments were encouraged but participating faculty were told that they could send a patient at that time who would be seen. All subjects must have a diagnosis of seizure or epilepsy. Trainees including residents and students participated in care. Support staff were instructed to permit 'walk-ins' regardless of insurance status. No diagnostic testing was required prior to the visit. We analyzed insurance type, show rate, generation of ancillary tests or surgeries, quality of educational experience and impact on support staff.Results: Clinic Data over 4 months was assessed. The show rate increased over time, ranging from 50% to exceeding 100%, averaging 69%. Average wait time for appointment: 7 days. Insurance status: 73% private insurance or Medicare, 27% Medicaid. 1.3 diagnostic tests or procedures were obtained per patient including Vagal Nerve Stimulator implant. Teaching quality of the cases received a score of 8.25 out of 10 (B+). Some cases were too challenging for students, others very easy for residents.Conclusions: This quick stop clinic permitted more rapid treatment for people with epilepsy who were having problems. It allowed us to be responsive to our ED colleagues who were reassured that a patient could be seen in less than 3 months. The demographics of the clinic suggest that access to urgent epilepsy care is not just an issue for the poor. The clinic necessitated a paradigm shift for support personnel but it refocused ancillary staff on a core patient care mission.