Abstracts

Rationale: The Epilepsy Learning Healthcare System (ELHS) created standardized outcome measures for providers and patients to be used as best practices within an epilepsy clinic. Of note are standardized documentation of seizure semiology and frequency in clinic notes. An ELHS aim is to reach and sustain a seizure frequency documentation rate of 80%. A chart review was designed using quality improvement methodology to assess the current documentation rates of four providers in the Barrow Neurological Institute (BNI) epilepsy clinic.

Methods: Four of the eleven providers at BNI participate in ELHS. 124 notes were reviewed from 10/26/20 to 5/21/21 using PDSA cycles, to assess and learn from current documentation methods. All providers had seen case report forms (CRFs) provided by ELHS but were not formally told that these metrics would be assessed. The required metrics were seizure semiology, with clear description of the seizure and ILAE classification, and seizure frequency. The results will serve as a baseline for QI interventions to achieve our documentation goal.

Results: The data is displayed on run charts which show the percent of provider notes with seizure semiology and seizure frequency documented over 14 clinic week intervals between 10/26/20 to 5/21/21 (Figure 1). Providers initially exceeded the goals for seizure semiology (81%) but did not meet the goals for seizure frequency (50%). There was one data point detected with a particularly low value reported for seizure semiology below the goal, which could be because one provider had a new scribe whose notes deviated from the expected provider note. One provider created their own dot phrase in their clinic notes to collect the required information about seizure frequency and semiology in a structured way. At the end of the 14-week assessment, all providers reported 100% seizure semiology and 100% seizure frequency. As the only intervention tested was email reminders, the data highlighted the variation in clinic note documentation.

Conclusions: Learning points indicate that providers adapted aspects of the CRFs to fit their current clinic note style but were not uniform across the four providers or consistent for the same provider’s notes. Most providers report their patient’s seizure frequency as free text within a summary which makes it hard to identify and some missed reporting the seizure frequency. Providers would report semiology generally by clearly identifying the types of seizures, but there were instances where there was no ILAE classification for the seizure, or the semiology was not clearly identifiable within the note. The run charts demonstrated that the system was stable from 3/1/21 onward which indicates a stable baseline for interventions to standardize documentation going forward, such as creating structured clinic visit note templates, and eventually expand the provider pool as well. In all, providers generally met and exceeded the 80% goals for seizure semiology and frequency but were not consistent in documentation from week to week, supporting the clinic’s aim to standardize clinic note documentation.

Funding: Please list any funding that was received in support of this abstract.: Epilepsy Foundation; Epilepsy Learning Healthcare System.