Abstracts

Rationale: As part of quality assurance, we investigated the readiness of the technologists to recognize seizures, and the nurses to respond to seizures in the epilepsy monitoring unit (EMU). Methods: We retrospectively analyzed seizures recorded from adult patients admitted for video-EEG monitoring in the EMU over 11 months. We included all epileptic seizures where the event button was pressed by the technologist monitoring the patient from the control room. We excluded seizures where the event button was pressed by the patient or caregiver before the technologist or when the nurse was already in the patient room at the beginning of the seizure. We extracted the onset and end times of the ictal electrographic discharges from the final reports dictated by the epileptologists. We defined the technologist response time as the delay between the onset of the ictal EEG changes and the time the technologist pressed the event button to indicate seizure. We defined the nurse response time as the delay between the time the technologist pushed the button and the entry of nursing staff into the patient room. We defined the intervention time as the delay between the entry of nursing staff into the patient room and the administration of rescue benzodiazepine per established protocol. Results: Among 46 seizures, 4 seizures were excluded for reasons noted above. Out of 44 seizures analyzed, the technologist response time was 0 -119 s (mean 30 s, 95% CI 21-39 s); the nursing response time was 2-114 s (mean 17 s, 95% CI 11-22 s). Among 17 interventions, the intervention time was 5-244 s (mean 105 s, 95% CI 71-139 s). Conclusions: Although we do not have a baseline for comparison, the mean technologist and nurse response times of <1 minute to an observed seizure in the EMU, and a mean intervention time of <2 minutes for intervention appear to be satisfactory. We are currently using this as a benchmark for training and quality control in the EMU. Future studies will involve assessment of outcome, such as termination of ongoing seizure or prevention of status epilepticus, after intervention.