Abstracts

Rationale: The Blue Bird Circle Clinic for Pediatric Neurology at Texas Children’s Hospital (TCH) cares for approximately 5,000 children with seizures each year. Between January and July of 2013, a total of 1,119 patients were seen in the emergency room (ER) for seizures at TCH. Forty-two percent of all ER admissions for seizures were existing patients of the neurology clinic. A quarter of these patients visited the ER at least twice during this 6 month period of time. The goal of this quality improvement project was to decrease emergency room admissions among existing TCH neurology patients by 50% by providing standardized seizure parent education in the neurology clinic. Methods: The Seizure Stoplight Tool was created by a multidisciplinary team including members of nursing, pharmacy, neurologists, and a nurse practitioner. The design was based on the concept of the asthma action plan, which is known for using the “green, yellow, and red” stoplight model for managing a chronic medical condition. The green zone encompasses seizure management, including daily medications and seizure triggers. The yellow zone includes factors that may increase seizure activity as well as pediatrician contact information. The red zone helps guide youth or caregivers in decision-making during an emergency. The plan is available in hard copy and in the electronic medical record in English and Spanish. The project was piloted by two nurses, who met with families at the end of the clinic visit to create and customize their Seizure Stoplight Tool based on the individualized medical recommendations of the provider and used the tool as a guide to educate the family. Results: Between 06/11/15 and 05/24/16, 53 patients received the Seizure Stoplight Tool and standardized education in the neurology clinic. Twenty-one of these patients were admitted to the ER 32 times prior to receiving the tool. After education with the Seizure Stoplight Tool, 9 of these patients were admitted to the emergency room 16 times, a 50% reduction in ER admissions. Four patients went to the ER both pre- and post- education with the Seizure Stoplight Tool. Only ER admissions for seizures were included. Limitations include small sample size, lack of data about precipitating factors to ER visits (intercurrent illness, medication non-adherence, etc). In addition, it is unknown if the patients had admissions to outside hospital ERs.  Conclusions: Receiving the Seizure Stoplight Tool and standardized seizure education from a nurse reduced the number of ER admissions among existing patients of the neurology clinic by 50%. Future goals of this project include continuing to expand the number of patients educated by utilizing the tool at time of discharge from the emergency room and epilepsy monitoring unit. Funding: N/A