Abstracts

Rationale: Providing a systematic approach to the diagnosis and initial treatment of nonepileptic spells (NES) in an inpatient Epilepsy Monitoring Unit can be difficult. Therefore, we developed a Spells Workup, Assessment, and Treatment (SWAT) team that provides acute, systematic intervention to patients diagnosed with NES in the hopes of reducing stress and ensuring followup with mental healthcare providers. Methods: The SWAT team consists of an EMU nurse coordinator, a neuropsychologist, a psychiatrist, a social worker, and an epileptologist. Patients diagnosed with NES in the EMU are informed of the diagnosis by the attending epileptologist who also explains the role of other members of the team. The neuropsychologist provides a diagnostic evaluation and makes specific recommendations for outpatient treatment. If the neuropsychologist determines that the patient may benefit from medication, a psychiatric evaluation is also performed by the psychiatry consulting team. The social worker subsequently meets with the patient to reaffirm the diagnosis and provide direct assistance in making appointments with the type of mental health professional recommended by the neuropsychologist and/or psychiatrist. The social worker also sends a cover letter and review article on NES to the mental health professional with whom the patient has been referred. The nurse discharging the patient from the EMU provides an education handout regarding NES to review the treatment plan. Effectiveness of the SWAT team was assessed by determining the proportion of patients who attended mental health follow-up visits. Stress reduction for healthcare providers was assessed by interview. Results: The SWAT team has been activated for 5 of the last 8 patients diagnosed with NES in the EMU. The SWAT team was unable to be fully executed in 3 patients because of inconsistency in available personnel. Determining the proportion with follow-up is ongoing. The treatment team reports less stress and anxiety from NES patients when the SWAT team is used.Conclusions: Using a SWAT team that provides a systematic approach for treatment of patients with NES reduces stress and anxiety for the healthcare providers and may increase follow up with mental healthcare providers. This is likely to improve outcome for these patients but more data is needed for statistical assessment.