Abstracts

Rationale: Status epilepticus (SE) is a common condition and a neurologic emergency requiring prompt treatment for the best outcomes. Since many patients with SE first present to the emergency department (ED), we developed a quality improvement project aimed to evaluate and increase knowledge of SE and its treatment in the ED. Methods: First, a survey testing knowledge on diagnosis and treatment of SE was created and distributed to all ED staff. Questions dealt with definition and duration of SE, first- and second-line treatment, and awareness and use of an existing SE order set (SOS) to improve treatment times. Surveys were provided during meetings and on-line. Responses were assessed, and as a second step, educational interventions targeting identified knowledge gape were developed. Two approaches were implemented: slides for an ED hallway computer screen and a didactic lecture. ED staff were re-surveyed to measure gain in knowledge. Lastly, electronic medical records (EMR) were queried before and after educational measures were employed (between 08/2016 and 03/2017) to find out whether usage of the SOS had increased (query: adults with SE, first diagnosed in ED, with or without SOS).  Results: The initial survey received few responses when distributed in meetings, but had more replies when sent out on-line. Ultimately, 5 technicians, 17 attendings, 23 nurses, and 34 residents provided answers. Sixty-two percent correctly responded to questions on SE definition, 100% knew that benzodiazepines are first-line treatment, and 85% identified phenytoin as second-line therapy. However, 94% did not know that a SOS was available. Educational efforts, i.e. hallway displays (08/2016 to 03/2017) and a lecture (02/2017), therefore focused on raising awareness and increasing use of the SOS. The repeat survey was sent out on-line about one month after a short didactic presentation. There were 22 responders (all residents), 41% now knew of the SOS, representing a 7-fold improvement of the number of residents aware of the SOS. EMR queries from 11/2015 to 05/2017 revealed that in 2016 (partly prior to intervention), 8 of 23 (26%) of patients diagnosed with SE in the ED had the order set placed by an ED provider. In 2017, up to 9 months after interventions started, 3 of 13 (19%) patients had a SOS placed by an ED provider, suggesting no gain in use of SOS related to our educational measures. Conclusions: SE often presents first in the ED and requires prompt treatment for best outcomes. A SOS can help ED providers treat SE quickly and according to guidelines. Initial surveys identified that most ED residents were aware of SE definition and treatments, but unaware of a SOS. Educational efforts clearly increased awareness of the SOS. Though, there is not yet evidence that more widespread knowledge has translated into increased usage of the SOS in our ED. Challenges regarding this project were unexpected difficulties in distributing surveys to all ED staff, obtaining responses, and administrative obstacles in educating personnel and providers after knowledge gaps were identified. Funding: None