Abstracts

Rationale: Untreated mood disorders and mental illness predictably contribute to poor outcomes, and in children with epilepsy, have been shown to decrease health related quality of life and increase health care utilization and costs (Guilfoyle SM. Epilepsy and Behavior 2015;44:5-10). Nearly 1/3 of school age children with epilepsy, and 3.7% of children without epilepsy have been formally diagnosed with a mood disorder (Alfstad KA et al. Epilepsy and Behavior 2016;56:88-94; National Institute of Mental Health, January 9, 2017). However, according to the National Institute of Mental Health, 43.8% of children with diagnosed mood disorders receive treatment in a given year, while only 33% of children with epilepsy and a concomitant mood disorder diagnosis receive treatment (Caplan R et al. Epilepsia 2005;46:720-14). We aimed to close this gap in screening and treatment of mood disorders through the use of quality improvement (QI) methodologies.Epilepsy monitoring units (EMUs) serve children with and without epilepsy. The non-epilepsy diagnoses made in the EMU unit are often related to patients’ underlying developmental, mood or psychiatric concerns. Thus, epilepsy monitoring units capture a unique population of children who are at increased risk for mood disorders. We utilized QI methodology to implement standardized screening for risk factors for mood and behavioral disorders in our EMU, using the Strengths and Difficulties Questionnaire (SDQ), validated in 4 to 17 year olds. Methods: The percentage of patients screened for mood disorders, as well as the percentage of at risk patients referred to psychology prior to their EMU admission was obtained from chart review. A multidisciplinary QI team developed a process map, key driver diagram and Pareto chart to focus interventions. Plan-Do-Study-Act (PDSA) cycles were utilized with adjustments when necessary. Data were tracked utilizing I-charts and p-charts and trends were identified employing accepted QI principles.Implemented interventions included: advanced form preparation and tracking for scheduled admissions, scripted communication to encourage participation and prepare families for psychology referrals, creation of an inpatient Epic flow sheet for data collection, and nursing education regarding distribution and collection of forms. Institutional Review Board approval was waived, as this work was performed for QI purpose Results: Record review determined that 15% of the patients admitted to the EMU prior to February of 2017 had been screened for mood disorders in the proceeding 2 years. Of the children identified as at risk for mood and behavioral concerns, only 15% had been referred to psychology.Fourteen months into the project, 59% of children in our EMU have been screened for mood and behavioral concerns using the SDQ.  Of the patients identified as at risk for psychological concerns, 54% have been referred to and evaluated by psychology. Both of these metrics exceed our initial goal of 50% improvement.  Data collection and PDSA cycles are ongoing, with updated analysis to be presented at the annual AES meeting in December 2018. Conclusions: Applying QI methodology improved the percentage of children admitted to the EMU who have been screened for mood and behavioral concerns, and increased the percentage of at risk youth successfully connected to psychology. Ongoing interventions, including digitizing the screening process with automatic upload to the EMR, are planned and anticipated to improve upon and maintain these initial accomplishments. Funding: None