Abstracts

Rationale: Reducing hospital admission length of stay (LOS) has been identified as one way to improve quality and reduce healthcare costs. The epilepsy monitoring unit (EMU) poses unique challenges to reductions in LOS, given the elective nature of the admissions and the need to safely provoke seizures. Data delineating the factors that impact EMU LOS are currently very limited. In an attempt to establish benchmarks for care, we evaluated the time to first, second, and third target events (TE) in patients admitted to the EMU at a large tertiary care epilepsy center.Methods: We reviewed the medical records of 905 consecutive patients who were admitted for diagnostic scalp video-EEG monitoring at NYU s Comprehensive Epilepsy Center from January 1, 2011 to December 31, 2011. Admission reason and time to TE were assessed.Results: 40.4% of patients (366/905) experienced a first TE; mean time to first TE for pre-surgical patients was 3.4 days (D) vs. 2.5D for non-surgical patients. 31.7% (287/905) experienced a second TE; the mean time to second TE was 4.4D for pre-surgical patients vs. 2.7D for non-surgical patients. 24.7% (224/905) experienced three or more TEs; the mean time to third TE for pre-surgical patients was 4.9D vs. 2.9D for non-surgical patients. Of the patients who experienced TEs during admission, 21.5% (79/366) had only one TE during admission; of these patients, mean LOS was 7.2D for pre-surgical patients (12/79) vs. 5.1D for non-surgical patients. 17.2% (63/366) experienced only two TEs during admission; mean LOS was 8D for pre-surgical patients (14/63) vs. 5.3D for non-surgical patients. 61.2% (224/366) experienced three or more TEs during admission; mean LOS was 6.7D for pre-surgical patients (54/224) vs. 6.3D for non-surgical patients. Conclusions: Time to first TE is longer in patients admitted to the EMU for pre-surgical evaluation vs. non-surgical patients. The latter group includes patients with psychogenic non-epileptic seizures; such patients produce events more quickly in EMUs (1). Slower AED reduction in refractory epilepsy patients is a potential contributor to longer LOS, and could explain the greater time to first, second and third TEs in the pre-surgical population. Non-surgical patients who experienced three or more TEs possessed a mean LOS approximating the pre-surgical group; events may have been challenging to characterize or patients may have become destabilized during AED changes. The finding that pre-surgical patients with only two TEs had longer LOS vs. patients with three or more TEs suggests there is a subset of the pre-surgical population that is more challenging to provoke. Identification of predictors of provocation resistance could assist in establishing guidelines for rate of AED withdrawal. These data provide initial benchmarks for the time necessary to capture diagnostic clinical events in both pre-surgical and non-surgical patients in the EMU. (1) Shin HW, Pennell PB, Lee JW, et al. Efficacy of safety signals in the epilepsy monitoring unit (EMU): should we worry? Epilepsy Behav. 2012;23(4):458-61.