Abstracts

Rationale: Inpatient video-EEG monitoring is an integral part of the clinical management of many individuals with epilepsy and non-epileptic events (NEE). Research on seizure monitoring units (SMU) usually focuses on their diagnostic utility. However, studies addressing the quality and safety aspects of SMUs are scarce. Our objective was to provide a baseline assessment of (a) the quality and safety of procedures on the SMU and (b) whether admissions goals were met.Methods: All hospital records for patients admitted to the SMU between February 2005 and May 2006 were identified. A random sample of 129 admissions (64% of all admissions) were reviewed. Descriptive variables included gender, age, developmental delay, place of residence, reason for admission, and admission urgency. Quality indicators included length-of-stay (LOS) and wait time by admission urgency. Safety indicators included level of antiepileptic drug (AED) reduction, complications, and interventions used to stop seizures. Whether the admission question was answered and whether management changes occurred as a result of the admission was also studied.Results: Fifty-one percent of patients were male and 11.6% were developmentally delayed. Mean age was 36.7 years (SD = 11.8). Forty-one percent of patients were from out-of-town and 12% were from out-of-province. The primary reason for admission was seizure characterization (n = 60; 46.5%) followed by surgical workup (n = 53; 41.1%), suspected NEE (n = 27; 20.9%) and quantification of spells (n = 8; 6.2%). Regarding quality indicators, mean LOS was 8.2 days (SD = 4.3). Mean admission wait time was 98.2 days (SD = 108.2 days, range = 1-573). Twenty-eight percent of admissions were urgent and the wait time for urgent admissions (mean = 62.9 days) was less than that for elective admissions [mean = 113.8 days; t(116) = 2.59, p = .01]. Regarding safety issues, all AEDs were discontinued in 49.6% and reduced but not stopped in 9.3%. In 20.9%, one or more AED was stopped but at least one drug was not discontinued. Complications occurred in 10.1% of admissions. This included 4 episodes of status epilepticus, 4 injuries (3 from seizures, 1 from a seizure-related fall), 4 IV infections, 2 hemorrhages related to intracranial monitoring, 1 CNS infection, and 3 other minor complications. Lorazepam (IV and sublingual) was the most common intervention used to stop acute prolonged or repetitive seizures (used in 24% of patients). Finally, the admission goal was met in 69.8% of patients, was partially met in 24% of patients, and was not met in only 6.2% of patients. Thirty-six percent of admissions resulted in management (AED) changes. Conclusions: The results of this study provide baseline data on key quality and safety indicators that can now be used to guide ongoing prospective quality and safety improvement initiatives in our SMU. In addition, admission goals were met in the majority of those admitted into the SMU, which provides further evidence of the utility of SMU admissions.