Authors :
Presenting Author: Emily Klatte, MD – OhioHealth
Bryan Berger, MD, MHA – OhioHealth; Angela Parsons, DO, MS – OhioHealth; Brianna Burns, MPH, CPHQ – OhioHealth; Deborah Graves, MHA – OhioHealth; Brad Raetzke, MD, MBA – OhioHealth; Jason Bisping, MD – OhioHealth; Amanda Dunlop, DNP, CNP, CNRN – OhioHealth; Tina Yates, DNP, MS, NP-C,ACNS-BC, CNRN – OhioHealth; Renee Pack, MSN, CNRN – OhioHealth
Rationale:
Epilepsy and convulsion diagnoses account annually for more than 1 million emergency room visits, 280,000 admissions, and $2.5 billion in hospital related costs (Examining the Economic Impact and Implications of Epilepsy, AJMC, Feb 2020). The importance of first seizure clinics is well established, but little is available regarding prevention of low acuity hospital admissions in patients with new onset seizures and established epilepsy. There is also a well-recognized gap in epilepsy care including health disparities and a delay in referrals to comprehensive epilepsy centers.
We created a rapid access seizure clinic, aiming to prevent unnecessary hospital admissions, bridge the gap in care, and decrease overall costs.
Methods:
OhioHealth consists of 14 hospitals and 24 total emergency rooms. Many patients with new onset seizure or known epilepsy do not require hospitalization, as long as rapid outpatient access exists. A multi-disciplinary team including neurology, hospital medicine, emergency medicine, and administration developed a pathway to prevent low acuity admissions
We identified clinical criteria for safe discharge and expected appointment times including urgent, one week or first available. We built a unique referral order which electronically routed to our scheduling department and identified a group of participating providers. Our process went live at our hub location in April 2020, with system expansion in December 2020.
Results:
A total of 611 referrals were placed through this process, with 280 visits being scheduled and 256 completed visits. Of these 256, 45% were deemed urgent, with 48% being seen within the expected timeframe (mean seven days). Of the 256 completed appointments, 57 referrals were placed to the epilepsy monitoring unit (EMU).
Patient demographics included an average age of 40 (17-89, 45% female, 55% male). Distribution of race included 68% Caucasian, 23% Black, and 9% Other. A majority of referrals consisted of patients living in the central market (79%). Significantly more Caucasian patients completed their visit compared to Black (46.5%/33%, p=0.05, chi-square test).
Conclusions:
We prevented over 600 hospital admissions since its inception in 2020, with a majority of patients being seen in the epilepsy clinic within seven days. Twenty two percent (22%) of patients seen in clinic were referred to the epilepsy monitoring unit.
It is known that fragmented care can result in diminished quality of care, with increased costs. The success of this initiative was in part due to the collaborative, multidisciplinary approach used in the operational design, engagement of our ED staff, and large geographic reach of our health system. Longer term follow up for patient retention and potential reduction in ED visits over time would be worth examining.
Notable findings included a significant difference in the percent visit completion by Caucasian vs Black patients, in line with known data regarding disparities in care for patients with epilepsy among the black community. The adoption of similar pathways by other health systems could help reduce costs of care and expedite appropriate patient care for patients with uncontrolled epilepsy.
Funding: NA