Abstracts

Rationale:  Psychogenic Non-Epileptic Events (PNEE) are a fairly common diagnosis in an Epilepsy Monitoring unit (EMU) accounting for approximately 20-30% of all admissions.   One of the goals of diagnosing PNEE is to ensure proper management including avoiding Emergency Department (ED) visits and obtaining treatment with a psychologist.  As part of a quality improvement initiative, our program instituted a multi-disciplinary education effort for inpatients with a diagnosis of PNEE including a follow-up phone call.  Our hypothesis was that these interventions would decrease subsequent ED visits. Methods:  Following IRB approval, we analyzed data for all patients admitted to our EMU from 1/1/2016 to 12/31/2017 with a discharge diagnosis of PNEE based on ICD10 coding.  ED visits were identified during the same time frame for each patient and were coded relative to when they were diagnosed with PNEE (i.e. before or after).  Demographic data for patients were also reviewed including age and gender and duration of events.  The patients’ subjective rating of how they were doing following admission (better, same, or worse) was assessed at the time of their three month follow-up call.  The patients’ success in obtaining a therapist/psychologist was also assessed.  Results: During the study period, a total of 488 patients were admitted to the EMU of which 100 (20.5%) were diagnosed with PNEE.  Of these 100 patients, there were 25 ED visits during the study time period of which 6 visits (in 4 patients) occurred following their EMU diagnosis.  Three of the four patients had a dual diagnosis of epilepsy and PNEE.  Of the 62 patients that could be reached for three-month follow-up by phone, 54.8 % reported their events were better, 43.5 % had no change in their events, and 1.6% were worse in their event count.  67 % received follow-up with a therapist and 32.8 % did not have a therapist appointment.  Conclusions: This study demonstrates that a majority of patients reported improvement in their PNEE following diagnosis and, similarly, a majority of patients reported successfully establishing care with a therapist following their EMU admission.  The results represent a significant rate of decline in the patients receiving the diagnosis of PNEE that utilize the Emergency Department following the interventions our EMU utilizes.  A limitation to this study is that we were not able to assess if a patient went to an ED outside of our Epic electronic medical record system.  Funding: None