Abstracts

Rationale: Status epilepticus (SE) is a life-threatening emergency. Fast treatment is mandatory to prevent neuronal injury and refractory SE. Although time to actual treatment in the field is captured in some studies, there are no data that reflect time to treatment and cessation of SE in the hospital setting. Treatment paradigms recommend therapy after 5 minutes of ongoing or recurrent seizures without return to baseline. The objectives of this study were to investigate whether implementation of a standardized treatment protocol would lead to faster time to diagnosis, treatment and faster resolution of SE, as a foundation for a hospital-based quality improvement initiative. Methods: All continuous EEG (cEEG) reports in our electronic medical record system (EMR) between 10/2012 and 12/2012 were reviewed to identify SE patients. Patients whose treatment was initiated at an outside facility or in the field were excluded. Abstracted data included: patient age, gender, presence or absence of pre-existing epilepsy, comorbid conditions, presumed etiology of SE and time and method of SE diagnosis. Outcome measures included: time to first and subsequent treatments, time to SE resolution and number of drugs used. We then created and implemented a standardized EMR order set (SOS) - adhering to established guidelines - and educated hospital staff about its use. The SOS included a medication algorithm which restricted immediate treatment to benzodiazepines coupled with either fosphenytoin or valproate as second drug, as well as cEEG, blood work and neurology consultation. Prospective clinical data was collected between 12/2012 and 5/2013. Outcome measures before and after implementation of the order set were compared. Mann-Whitney tests were used for statistical analysis.Results: Data from 24 patients were included (n=12 before SOS implementation and n=12 after SOS implementation). After SOS implementation, 13 additional patients were treated for SE, but not with the proposed SOS and were therefore were excluded from this analysis. Demographic and timeline data is presented in Table1. There was a significant reduction in time to first and second treatment and resolution of status epilepticus after SOS implementation. There was no difference in time to diagnosis of SE for either group. There was a trend towards fewer drugs needed for cessation of SE after SOS implementation. Conclusions: Implementation of a standardized SE order set, along with education about SE, significantly shortened time to treatment and resolution of SE in our institution. However, it did not improve time to recognition of SE, which can have variable clinical manifestations. Future goals are to increase educational efforts to improve identification of SE and to detect barriers to faster treatment.