Abstracts

Rationale: Epilepsy or seizure care is the most common neurological condition that presents to an emergency department (ED).Methods: A comprehensive quality improvement (QI) project utilizing the Institute for Healthcare Improvement (IHI) model in hopes of decreasing ED utilization for children with epilepsy was conducted at a free standing children’s hospital. IRB approval was not necessary as the work performed was for QI purposes. Epilepsy patients were identified using ICD nine and CPT coding. Baseline monthly ED visits, as well as unplanned hospitalizations, for epilepsy patients and associated healthcare costs were determined. A multidisciplinary QI team was developed for this project. The team consisted of a pediatric epilepsy specialist, an epilepsy nurse practitioner, a pediatric emergency medicine physician, an epilepsy social worker, a neurology triage nurse, an inpatient neurology nurse, a neurology pharmacist, neurology administrative assistant, and a QI process data specialist. The group was tasked to develop interventions aimed at reducing ED visits and unplanned hospitalizations using QI methodology. We report our work as presented using the SQUIRE guidelines. Interventions that included: creating an urgent epilepsy clinic; dosing reminders for seizure abortive medications; instructional magnets; and, use of alternative seizure treatments in a specialized clinic were implemented. In addition, monthly reviews of patients who seen in the ED for seizure related care were performed based on high risk defined as 4 or more ED visits and rising risk defined as 2 or more ED visits in 12 months. Plan do study act (PDSA) cycles were utilized with adjustments made when needed.Results: Nineteen months following implementation of the interventions, ED visits were reduced by 29% in past year. Additionally, the average number of inpatient hospitalizations per month was reduced by 43%. For both outcome measures, a 2-sample Poisson rate exact test yielded a p-value < 0.0001. Annually, a savings to healthcare utilization of $115,200 was noted for ED reduction and $1,951,137 for hospitalization reduction. Our balancing measures included seizure related hospital readmissions which decreased from a baseline of 22 in 2012 to 12 in 2014 while readmissions for other neurological conditions remained virtually unchanged (18 to 21).Conclusions: Applying QI methodology was highly effective in reducing ED utilization and unplanned hospitalizations for children with epilepsy, thus resulting in significant cost savings. Further reduction in unplanned healthcare utilization can likely occur with additional initiatives and data analytics. We are currently applying care coordination to assist patients with a potential for high ED utilization for their epilepsy care in hopes of further improvements. Data analytics and predictive modeling can help providers make decisions to give optimal care, which in turn can reduce otherwise preventable healthcare utilization.