Abstracts

Rationale: Epilepsy surgery has been shown to improve seizure outcome and reduce patient mortality. Access to specialized epilepsy care and specifically resective epilepsy surgery, can be a prolonged process involving multiple steps. As part of a quality improvement project, we retrospectively reviewed the number of epilepsy surgeries (including invasive monitoring without resection, excluding VNS) and determined the baseline evaluation time (ET), i.e. the time from non-invasive video-EEG monitoring (Phase 1 = P1) to surgery. We then implemented new measures to improve access and reduce time to epilepsy surgery. Subsequently, we re-evaluated the number of surgeries and ET to assess the impact of those measures. Methods: The University of Colorado Hospital patient database was searched for all epilepsy surgeries between January 2009 and May 2014. Time from P1 to essential steps within the evaluation process, including neuropsychological testing (NPT), Wada testing, presentation in patient care conference (PCC, a panel of epileptologists, radiologists, neuropsychologists, and surgeons), and surgery was determined. Measures to improve access to surgery, included: 1) increasing the PCC frequency (from once monthly to once weekly) and instituting preferred scheduling of patients for test with longer wait times, like NPT and Wada; 2) adding a dedicated epilepsy surgery clinic for review of results, education, planning of further testing, and referral to neurosurgery; and 3) hiring a nurse navigator to coordinate the process (Table 1). Surgery numbers and evaluation times, including the break down of time from P1 to NPT, Wada, and PCC, were determined for two groups: 1) the baseline group (Group 1), patients who underwent P1 between January 2009 and March 2013 and 2) the group following process changes (Group 2), patients who underwent P1 during or after April 2013. Student's t-test was used to compare the means between groups. Results: Results are depicted in Table 2. The interventions aimed at expediting the process to epilepsy surgery in appropriate candidates significantly lowered the average ET by 117 days (p = 0.003). Time to evaluation components was also significantly reduced: from P1 to NPT by 85 days (p = 0.003), from P1 to Wada by 68 days (p = 0.022), and from P1 to PCC by 153 days (p = 0.0001). The total number of surgeries was 75 in Group 1 and 25 in Group 2. This represented an increase in surgeries, but was not statistically significant. The full effect of some elements targeting process improvement that were introduced later may not have been apparent. The impact of each individual intervention could not be determined. Conclusions: Implementing more frequent PCCs, quicker access to testing, specifically to tests with longer wait times like NPT and Wada, a dedicated clinic and a coordinating nurse navigator significantly decreased the time from P1 to resective epilepsy surgery. Similar strategies could be utilized in other centers to reduce wait time to surgery and thereby improve patient safety due to lower morbidity and mortality associated with better seizure control.