Abstracts

Rationale: Status epilepticus (SE) is a medical emergency and a frequent reason for hospital admission. Approximately 20% of patients presenting with SE die within 30 days, with higher mortality associated with longer duration of SE. Success in treatment of SE is associated with reducing duration, which can be dependent on timely intervention and adherence to a treatment protocol. We hypothesize that reducing the complexity of placing orders for the management of SE will decrease the duration that patients remain in SE and thus will improve patient safety by decreasing need for intubation, length of hospital stay and also lead to improved patient outcomes. We sought to optimize the efficiency of treatment orders and administration by development and implementation of a specific SE order set within our electronic medical record (EMR). Methods: We first reviewed data for 6 months to determine patterns of medication timing and usage for SE presentation to the emergency department (ED). We then created an order set for the management of SE into our EMR. Features include: general guidelines for medication selection and dosing for treatment of SE, a one-click link to ordering a neurology consultation, and a one-click link to order continuous electroencephalogram (EEG) monitoring. Use of the order set also alerts the pharmacy that the medications are for the treatment of SE and should be expedited. We provided education and pocket cards for the use of the order set to the neurology residents and faculty as well as the ED residents and faculty in January 2014. The specific quality measures tracked are: time to administration of appropriate treatment, time to resolution of SE, need for intubation, length of stay, and Glasgow Outcome Scale at 1 month after presentation. Results: Prior to implementing the order set,the time from arrival in ED to first in-hospital treatment ranged from 1-745 minutes (mean 91.06). The time between placing the order and patient receiving dose ranged from 0-52 minutes (mean 4.81). Since implementation, the order set has been used in approximately 70% of cases of SE. Patients treated within the order set had reduced and more consistent times to administration of SE treatment. Updated data will be presented for patients who received treatment via the SE order set versus those that did not, as well as comparison between SE patients treated before and after implementation of the order set. Conclusions: Our order set has been successfully implemented into the EMR since January 2014 and is routinely utilized now by both our neurology and ED residents. Use of the order set has afforded the opportunity for increased education and prompt communication with the ED about SE. Based on our initial results showing increased efficiency of treatment in SE, we also plan to implement and track the protocol in other areas including the medical and surgical ICUs, and medical and surgical floor services.