Abstracts

Rationale: The quality and safety of hospital care is becoming increasingly important as health care costs rise and clinical error is scrutinized. Admission to a seizure monitoring unit (SMU) is unique in that (a) it is often elective rather than acute; (b) medication is reduced to generate symptoms rather than increased to stop symptoms; and (c) a variety of disciplines are consulted which are not standard for other inpatient admissions. Thus, typical hospital quality and safety guidelines often do not apply to SMUs. We describe a newly implemented SMU quality and safety improvement program geared towards establishing such guidelines.Methods: (a) Development of SMU Quality Improvement (QI) Team: With the guidance of the Neurosciences Department QI Consultant, a multidisciplinary team was developed with representatives from the various individuals involved in the SMU: EEG technologists; nursing staff; epileptologists; a psychologist; and a patient. (b) Informal Survey of Canadian Epilepsy Centres with SMUs: A survey was conducted of 12 Epilepsy Centers in Canada, exploring how they monitor the quality and safety of the SMU. (c) Program Evaluation Initiatives: Based on the program evaluation literature, we developed a Logic Model and initiated a project to identify key quality and safety indicators to track prospectively. These were based on QI principles of safety, timeliness, efficiency, effectiveness/clinical outcomes, and utilization. Finally, we identified priority projects and developed sub-teams to initiate PDSA (Plan, Develop, Study, Act) cycles, following the methods recommended for QI initiatives.Results: (a) SMU QI Team: The multidisciplinary team is led by the psychologist and the QI consultant, with representatives from every aspect of the SMU, including a patient. (b) Informal survey: Eight of 12 Canadian SMUs responded to the survey. Number of beds ranged from 1-8 (mean = 3). Half were open 7 days/week and the other half were open Monday-Friday. Number of admissions/month ranged from 4- 40 (mean =12). Although each program had an SMU management team, none had a team devoted to monitoring quality and safety. One-third of programs evaluated staff satisfaction and one-quarter used informal means to evaluate patient satisfaction. No program had a formal evaluative process for patient satisfaction. (c) Program Evaluation Initiatives chosen for implementation: Developing objectives to guide SMU QI initiatives; quality indicators and baseline information; formal patient and staff satisfaction surveys; patient and staff education; enhancing staff consistency; tracking seizure induction procedures; and improving the safety of seizure management.Conclusions: This project demonstrates that developing a multidisciplinary quality and safety team for SMUs is feasible and necessary. By having a SMU QI Team in place, we hope that patient and staff satisfaction can be improved, patient and staff education will be enhanced, and ultimately complications, length of stay and wait times may be reduced.