Abstracts

The A Team: A Cohesive Care Model That Includes the Pediatric Epileptologist and Advanced Practice Provider in the Epilepsy Monitoring Unit

Abstract number : 2.351
Submission category : 15. Practice Resources
Year : 2021
Submission ID : 1826646
Source : www.aesnet.org
Presentation date : 12/9/2021 12:00:00 PM
Published date : Nov 22, 2021, 06:55 AM

Authors :
Nassim Zecavati, MD, MPH - Children's Hospital of Richmond at VCU; Ewa Way – Children's Hospital of Richmond at VCU; Lawrence Morton – Children's Hospital of Richmond at VCU

Rationale: The purpose of this abstract is to describe the development of a Pediatric Epilepsy Monitoring Unit (EMU) that incorporates Advanced Practice Providers and the pivotal role this partnership can play in promoting cohesive care in the pediatric EMU.

A model of cohesive care requires a tightly knit patient-oriented team to combat the many factors that lead to fragmented care. Patients and their families are the central and key element in a team-based approach. As with any team, there needs to be a leader, clear roles and responsibilities for the members, and the ability to coordinate collaboratively to efficiently deliver care across all settings. The challenge of caring for a growing and complex pediatric population with complex neurological and psychiatric needs mandates the need for robust and innovative health care teams. A team based approach in the EMU varies substantially from one institution to the next but an effective one includes epileptologists, Advanced Practice Providers (APPs), EEG technicians, child life specialists, nurses, social workers and neuropsychologists as potential solutions to this problem.

Methods: A retrospective analysis of our 6 bed Epilepsy Monitoring Unit was performed from the period of January 1 to December 2020 to better understand our EMU volume and patient needs with categorization of pediatric studies as routine, EMU, or ambulatory. Our hypothesis was that our growth could not be sustained without additional support. We thus employed an APP and epileptologist model of care in the routine day to day care of the pediatric EMU patient.

Results: Over a period of 12 months, 744 pediatric EEG studies were performed at our institution, a level 4 NAEC Epilepsy Center. These included 481 routine EEG studies, 133 ambulatory studies, and 130 EMU studies. We developed a cohesive team of specialists that includes 3 pediatric epileptologists and 4 APPs with specialized training in epilepsy. Individual teams in the EMU consist of an APP paired with an EMU attending for in person rounds in addition to virtual and in person rounds with learners such as medical students, residents and fellows. Responsibilities were clearly delineated at all levels with our pediatric epileptologist leading the team, providing EEG interpretation and making management decisions. APPs executed the care plan as discussed during rounds and were responsible for documentation, orders, and communication with nursing and EEG technicians. There were frequent check ins with patients and families by the APP and attending. The main responsibility of learners including residents and fellows was to learn the fundamentals of EEG interpretation with an emphasis on seizure recognition, both clinically and on EEG.

Conclusions: The implementation of a joint epileptologist and APP care team has allowed our institution to meet the growing needs of our community and that of an increasingly complex pediatric epilepsy population. Although further data is needed to better understand various care models, we propose integrating APPs into neurologic teams as one model of team-based care to improve access and quality of care.

Funding: Please list any funding that was received in support of this abstract.: No funding was received in support of this abstract.

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