Abstracts

Rationale: There are inconstancies in the work up of new onset seizures in the emergency department (ED) in the community hospital setting. This leads to wasted resources and dissatisfaction to both patients and providers. By facilitating communication among providers and expediting outpatient work up, a more efficient work up and improved satisfaction could be achieved. It was also hoped that could be measured with decreased hospital admissions, cost and length of time for follow up could be improved.Methods: A literature review was performed to determine the recommended evaluation. Six months of baseline data was obtained capturing all patients having new onset seizures with a normal neurologic exam in the ED for total billing, and whether a head CT was performed and whether the patient was admitted. ED and neurology staff was then briefed on the new protocol of a phone consultation on stable and neurologically normal patients before testing was performed in the ED and a plan was reached by collaboration between the two providers. However, each decision regarding patient care was ultimately left to the treating ED provider. The patient called the clinic for a consultation and was offered an appointment within two weeks for evaluation. The neurology clinic held openings for ED patients two weeks out to accommodate these patients. An EEG or MRI could be ordered prior to evaluation if the neurologist requested either test prior to evaluation in the neurology clinic. Data on all patients was collected for three months and compared to the baseline. Surveys were also conducted pre and post with the ED providers regarding workup and satisfaction with the project.Results: The percentage of initial head CT's decreased from 79% to 33 % (p value of <0.01). The total ED billing decreased from a mean of $8392 to $4226 (p value of < 0.02). Admissions decreased from 25 % to 8.3 % and average time to neurology evaluation from 19 days to 5 days. Survey of the ED providers after 3 months of the new protocol showed most, but not all, ED providers thought the process was better.Conclusions: By improving communication at the time of the initial ED visit between departments, we were able to positively impact measurable outcomes. Decreased admission rates and cost help to better manage limited resources. Trends were seen in decreasing the number of head CT, which decreased radiation exposure for the patients. Decreasing the length of time it took for a neurology evaluation was a satisfier for the ED providers. By having dedicated appointments for ED patients, the neurologists were able to meet the expectation of the ED.