Abstracts

Rationale: Introduction: Mortality increases significantly in patients who have delayed treatment of status epilepticus. While there are specific scenarios in which STAT electroencephalograms (EEGs) are helpful for making clinical decisions in status epilepticus, there are no universally accepted protocols for ordering this study. Ordering STAT EEGs inappropriately has lead to frustrations experienced by ordering services and EEG technologists/epileptologists, time and effort directed away from outpatient EEGs, and difficulty in prioritizing patients based on acuity. Purpose: To identify shortcomings of current STAT EEG protocols at Memorial Hermann Texas Medical Center in Houston Texas and develop an efficient protocol, to allow for systematic delivery of better healthcare and improve patient safety.Methods: The study was conducted from 2013-2015 by fourth year neurology residents, neurophysiology fellows, and faculty members of the epilepsy and neurophysiology department as part of Quality Improvement (QI) efforts in the neurology department. At least 3 major iterations of the Plan-Do-Study-Act (PDSA) Cycle were implemented. During the first iteration of the PDSA Cycle, with the help of hospital-wide surveys, current perception of the STAT EEG process and limitations were determined. The second round of the PDSA Cycle involved developing an algorithm for how to order STAT EEGs and creating interactive order-sets in the electronic medical records (EMR) to guide physicians on ordering STAT EEGs. The third iteration of the PDSA Cycle involved conductingeducational sessions and placing posters with the current STAT EEG protocol in high visibility areas in certain units. . Surveys were conducted before and after the intervention to determine knowledge of the indications for STAT EEG, the perceptions about the process and elecit suggestions as to how to improve the process.Results: At the beginning of the study there was a perception that STAT EEGs were difficult to obtain. Only about 36 % of non-neurology participants knew the appropriate indication for requesting a STAT EEG. Despite having algorithm posters and education sessions the number of STAT EEGs ordered for correct indications only had a small increase (38%). In some units, such as the Neuro-trauma intensive care unit (NtICU), the percentage of STAT EEGs being ordered rose from 6% (July-September 2012) to 30% (January –March 2015). STAT EEGs were often ordered when in fact continuous monitoring was indicated. Further chart review suggested that all of the requests from the NtICU in January 2015 were not indicated. Forcing the ordering attendings to seek approval from the epileptologist on call did decrease the percentage of STAT EEGs ordered from the NtICU from 30% in January 2015 to 16% in March 2015.Conclusions: Since there is a high turnover volume of residents and fellows in each department, educational efforts were not effective in decreasing the over use of STAT EEGs, however forcing the ordering physician directly seeking approval for STAT EEGs was more effective in decreasing the number of inappropriate requests for STAT EEGs.