Abstracts

Rationale: Intractable epilepsy is the failure of two or more appropriately chosen anti-seizure medications (ASM). In children with intractable epilepsy, referral to a Level 4 epilepsy center is important to determine if they are a candidate for additional therapeutic options, including surgical resection or ablation of epileptogenic focus, neuro-modulation, or the ketogenic diet. Identifying appropriate patients in a multi-specialty neurology practice is the first step to assuring best patient care. The Phoenix Children’s Neurology department evaluated our internal referral pattern through the use of an epilepsy specific dashboard (Figure 1).

Methods: Potential patients eligible for referral were identified via an epilepsy dashboard if they had a diagnosis of epilepsy (ICD 10 code of G40), were on two or more ASMs, and were not being followed by an pediatric epileptologist. Each week, the dashboard displayed eligible patients, with appointments in the upcoming three weeks, along with a link that allowed direct electronic chart review. One of the authors (JF), performed the chart review on individual patients and electronically categorized the patients into 3 groups; (a) referral needed, (b) referral not needed, or (c) questionable (i.e., more data needed). Those in the referral needed group had an automated email sent to the primary neurologist suggesting a referral. The dashboard also tracked which of these patients were actually seen by an epileptologist and whether this resulted in a change in treatment.

Results: Of the total 5683 epilepsy patients actively followed in our program, 286 (4%) were identified by the electronic dashboard as meeting criteria for referral over a one-year period. Of those, 189 patients with upcoming appointments underwent chart review. Of those, 158 (84%) were categorized as not needing a referral or were questionable, while 31(16%) patients were identified as needing a referral. Of the 31 patients, 19 (61%) were referred to and seen by an epileptologist, and in 14 (74%) of the 19 patients, this resulted in a change in treatment. The ketogenic diet was started on 3 patients, 3 had Vagal Nerve Stimulator (VNS) placed or optimized, and 8 patients had optimization of medications. Of those, 4 were able to come off at least 1 anti-seizure medication. No major changes were made to the treatment regimen in 4 patients and 1 patient may have been misdiagnosed with epilepsy.

Conclusions: Using this system, a single epileptologist was able to effectively screen a large pediatric epilepsy population, review the majority of potential patients, identify those eligible for referral, and ensure referral. This ultimately resulted in change of treatment for the majority (74%) of the patients referred and reduction in ASM in 21% of patients. In conclusion, an electronic epilepsy-specific dashboard improved quality of care for refractory epilepsy patients by facilitating the automated identification and internal referral of these patients to an epileptologist, while also providing a workflow for chart review, referral, and following outcomes after the referral.

Funding: None