Abstracts

Rationale: Ketogenic Metabolic Therapies (KMT) are high in fat, adequate in protein with low carbohydrate intake and are medically managed and primarily utilized as a treatment for intractable epilepsy. Carbohydrates from diet, medications, and personal care products are restricted to induce nutritional ketosis. Unintentional Carbohydrate Exposure (UCE) can lead to increased seizures in much the same way as missed medications. KMT requires careful monitoring of patients, both in and outpatient to prevent adverse side effects such as constipation, kidney stones, impaired growth, or heart arrhythmias. Optimal management for patients on KMT entails outpatient clinic visits with the primary epileptologist and ketogenic dietitian at 3-month intervals with lab monitoring and annual EKG and RUS. However, with growth of the ketogenic program, scheduling difficulties and tracking laboratory results of these patients led to gaps in care. Inpatient management requires the ability to identify patients admitted who are on KMT and ensure no UCE occurs during hospital admission. Our objective was to improve the ability to track patients on KMT and prevent complications of KMT through appropriate lab monitoring and follow up in ketogenic clinic and reduce unintentional carbohydrate exposure (UCE) during hospital admissions.

Methods: A multidisciplinary group consisting of information technology (IT), epilepsy, ketogenic dietitians and scheduling discussed gaps in care and how to provide monitoring for patients on KMT. A dashboard for patients with "Ketogenic Diet" Significant Event entered into their chart by our ketogenic diet team was created by the IT department to help identify and track various aspects of KMT patient care such as admissions, patient appointments, lab monitoring and UCE. The Ketogenic Dashboard launched on February 10, 2021. 13 patients out of 113 on KMT were identified as not having follow-up appointments for ≥ 90 days (range 91-574 days). A link on the dashboard was created for ketogenic dietitians to notify scheduling which patients need to be scheduled and with which providers. Scheduling reviews the dashboard daily to contact patient families without a follow up appointment.

Results: Within 6 business days of utilizing the Ketogenic Dashboard, 11 of 13 patients without a follow up appointment were scheduled. Once the appointment was scheduled, the patient falls off the list of overdue appointments on the dashboard. 2 patients could not be reached for follow up. Prior to the dashboard, 11.5% of patients were not scheduled for follow up. This number dropped to < 1%. For inpatient monitoring, the dashboard allows for assessment of any patient on KMT along with a list of their current medication and nutrition orders. The ketogenic dietitian reviews the information to ensure orders are correct to reduce UCE during admission.