Reduced Emergency Department Utilization by Patients With Epilepsy Using QI Methodology.

BACKGROUND: Epilepsy or seizure care is the most common neurologic condition that presents to an emergency department (ED) and accounts for a large number of annual cases. Our aim was to decrease seizure-related ED visits from our baseline of 17 ED visits per month per 1000 patients to 13.6 ED visits per month per 1000 patients (20%) by July 2014. METHODS: Our strategy was to develop a quality improvement (QI) project utilizing the Institute for Healthcare Improvement model. Our defined outcome was to decrease ED utilization for children with epilepsy. Rate of ED visits as well as unplanned hospitalizations for epilepsy patients and associated health care costs were determined. A QI team was developed for this project. Plan do study act cycles were used with adjustments made when needed. RESULTS: Nineteen months after implementation of the interventions, ED visits were reduced by 28% (from 17 visits per month per 1000 patients to 12.2 per month per 1000 patients) during the past year. The average number of inpatient hospitalizations per month was reduced by 43% from 7 admissions per month per 1000 patients to 4 admissions per month per 1000 patients. For both outcome measures, a 2-sample Poisson rate exact test yielded a P value < .0001. Health care claims paid were less with $115 200 reduction for ED visits and $1 951 137 reduction for hospitalizations. CONCLUSIONS: Applying QI methodology was highly effective in reducing ED utilization and unplanned hospitalizations for children with epilepsy at a free-standing children's hospital.

Reduction of emergency department visits using an urgent clinic for children with established epilepsy.

BACKGROUND: Emergency department (ED) visits and hospitalizations account for a large portion of the cost of care in people with established epilepsy. In an attempt to decrease seizure-related ED visits, we created an urgent epilepsy clinic (UEC) for children with epilepsy. Our aim was to decrease ED visits for patients seen in the clinic by 30% and decrease unplanned hospitalizations by 10% 3 months following an appointment. METHODS: Children at risk for an ED visit or unplanned hospitalization were referred and seen by a nurse practitioner and social worker. Factors influencing the need for the appointment and actions taken were recorded. Cost savings were also calculated. RESULTS: A total of 317 patients were seen in the UEC clinic from October 2013 to July 2015. Ninety-three percent of scheduled patients completed their appointment, compared to 84% in other neurology clinics. Eighty-three percent of patients were seen in the clinic within 5 days of the referral. Children were significantly less likely to come to the ED in the 3 months after an appointment compared to the 3 months before. CONCLUSIONS: An urgent clinic for children with established epilepsy was associated with a reduction in ED visits for seizures and improved adherence to outpatient clinic appointments for seizures. Further research is needed to evaluate the cost-effectiveness of UECs, and to compare health services and clinical outcomes to those of children without access to such services.

Optimizing Care With a Standardized Management Protocol for Patients With Infantile Spasms.

The primary aim of this quality improvement initiative was to increase the number of patients receiving first-line therapy (adrenocorticotropic hormone, corticosteroids, vigabatrin) as the initial treatment for infantile spasms. We implemented a standardized management protocol for infantile spasms based on the best available data and expert consensus. To assess the impact of this intervention, we compared the 3-month remission rates between prestandardization (January 2009 to August 2012) and poststandardization (September 2012 to May 2014) cohorts. We found that the percentage of patients receiving first-line therapy as the initial treatment was 57% (31/54) in the prestandardization cohort and 100% (35/35) in the poststandardization cohort (P < .001). The rate of infantile spasms remission was higher poststandardization compared to prestandardization (78.8% vs 30.6%, P < .001). Management standardization led to all patients receiving first-line therapy as the initial treatment and was associated with a significantly improved rate of infantile spasms remission 3 months after diagnosis.