Rationale:
An effective EMU admission should lead to accurate diagnosis of epilepsy by capturing and characterizing a paroxysmal event. An accurate diagnosis will help in choosing the right antiepileptic drugs, avoid unnecessary medication and diagnostic delay in non-epileptic patients. The aim of the study was to identify the reasons for in-effective EMU admissions, and to formulate and implement interventions to improve the effectiveness of EMU admissions by at least another 10%.
Methods:
We used the PDSA (Plan-Do-Study-Act) method for implementation.
|
Cycle
|
Month and Year
|
Intervention
|
Efficiency of admission
|
|
Cycle 1
|
Nov and Dec 2021
|
Collection of baseline data over 2 months in Nov and Dec 2021
|
53.5%
|
|
Cycle 2
|
March 2022
|
Charts monitored for telephone encounters or my chart message for decrease in seizure frequency, If changes noted admission were postponed
|
76%
|
|
Cycle 3
|
April 2022
|
Charts monitored for telephone encounters or my chart message for decrease in seizure frequency and or AED changes, If changes noted admission postponed
|
52%
|
|
Cycle 4
|
May 2022
|
My chart message was sent to families about 10 days prior to admission asking for change in seizure frequency, if families responded with change in frequency admission was postponed
|
51%
|
|
Cycle 5
|
June 2022
|
My chart message was sent to families about 10 days prior to admission asking for change in seizure frequency and or AED changes, if families responded with change admission was postponed
|
53%
|
|
Cycle 6
|
July 2022
|
My chart message was sent to families about 10 days prior to admission asking for change in seizure frequency, AED changes or adherence, if families responded with change admission would be postponed
|
62%
|
|
Cycle 7
|
Aug 2022
|
all above interventions continued
|
65%
|
|
Cycle 8
|
September 2022
|
all above interventions continued
|
65%
|
|
Cycle 9
|
October 2022
|
all above interventions continued
|
78%
|
Results:
![results.png (505×311)]()
• Cycle 1 – The results showed that most common goal of EMU admission was spell characterization and the main reason for failed EMU admission were infrequent spells.
• Cycle 2 to Cycle 6 – We were able to postpone or cancel about 1– 4 admissions each month through above interventions.
• Cycle 7 – 9 also we were able to postpone 0 – 1 admission.
• We were able to improve the efficiency of admission by at least 10% through these interventions.
Despite interventions there were some failed admissions for spell characterization due to either families not responding to my chart message or by not mentioning about the decreasing spells or AED dosage changes.
Conclusions:
Passive and active monitoring of charts for changes in seizure frequency, antiepileptic dosage changes and adherence prior to EMU admissions can help improve the efficiency of EMU admissions for spell characterization.
Having a designated person to call families prior to admission and clarifying spell frequency, AED changes and adherence could further help in cost effective event characterization.
Funding: None