Abstracts

Rationale: Studies have examined the role, impact, and manner in which PNES diagnosis is delivered. However, few have directly assessed the utility and potential individual and system-wide cost savings of inpatient psychiatric consultation for this population. This study will attempt to define the large PNES population served by the Parkland Memorial Hospital's Epilepsy Monitoring Unit (EMU). It will assess the influence of a diagnosis of PNES, psychology/psychiatry consultation during the evaluation process, and provision for neurology outpatient follow-up on the recurrence of symptoms and health care utilization after a diagnostic EMU stay. Methods: This study examined medical charts from 115 patients who were diagnosed with PNES during EMU VEEG seizure characterization admitted between Jan and Dec 2011. Health care utilization was assessed for the 12 months prior and subsequent to PNES diagnosis, analyzing all outpatient, urgent care, and emergency department encounters within the Parkland Health and Hospital System in Dallas, TX. Results: Results indicate a statistically significant decline in post-diagnosis all-cause health care encounters (ER, outpatient, inpatient), as well as neurologic/PNES encounters (p <= 0.05). This theme held for patients referred to at least once neurology follow-up (p <= 0.05) as well as to patients provided psychiatry/psychology consultation during EMU stay (p <= 0.05). Conclusions: This study contributes to the growing body of evidence that indicates precise and punctual diagnosis of PNES via VEEG can contribute to significant cost savings. Routine psychiatric consultation for PNES diagnosis may contribute to further realized savings as well as an established introduction to psychiatric follow-up, a mainstay of treatment. This study informs a pilot project to improve the transition to and novel treatments within psychiatric aftercare for patients with PNES.