Decreasing Seizure Treatment Time Through Quality Improvement Reduces Critical Care Utilization

Ostendorf, Adam P.; Merison, Kelsey; Wheeler, Tamara; Patel, Anup D.

doi:10.1016/j.pediatrneurol.2018.05.012

Cited by 27 publications

(25 citation statements)

References 27 publications

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“…19 In a pSERG tertiary care pediatric hospital, implementation of process improvements developed through quality improvement and statistical process control methodology doubled the proportion of patients receiving a first BZD within 10 minutes, thereby resulting in decreases in morbidity, transfer to the ICU, and costs. 20 This study did not only show that multidisciplinary quality improvement projects may reduce time to treatment, but it also showed the magnitude of the downstream consequences: need for ICU transfer was reduced from 39% to 9% of SE cases, reducing hospital charges by $2.1 million in a single hospital. These data highlight the need for pSERG-wide multidisciplinary, systems-focused approaches that include streamlining of communication; formal dissemination of the research findings on the importance of a timely treatment to all stakeholders; policy changes to streamline drug delivery; a standardized education of caregivers, emergency medical services, and emergency room personnel about specific steps to treat SE in a timely manner to avoid unnecessary delays and redundant interventions (table 4); and ultimately financial motivation for payers and health care systems to implement care improvements.…”

Section: Discussionmentioning

confidence: 75%

“…17 Interdisciplinary quality improvement interventions have shown that it is possible to improve time to treatment of electrographic seizures in the intensive care unit (ICU) 18 and time to treatment of SE in the hospital. 19,20 There are no data on whether publication of evidence on delayed treatment in SE has independently modified time to treatment. We aimed to address this gap in knowledge by comparing time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in time to treatment within the Pediatric Status Epilepticus Research Group (pSERG).…”

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confidence: 99%

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confidence: 99%

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Association of guideline publication and delays to treatment in pediatric status epilepticus

Fernández¹,

Abend

Amengual‐Gual

et al. 2020

Neurology

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Objective:To determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the pediatric status epilepticus research group (pSERG) as assessed by patient interviews and record review.Methods:We performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month to 21 years of age) with rSE.Results:We studied 328 patients (56% males) with median (p25-p75) age of 3.8 (1.3-9.4) years. There were no differences in the median (p25-p75) time to first benzodiazepine (BZD) [20 (5-52.5) minutes versus 15 (5-38) minutes, p=0.3919], time to first non-BZD anti-seizure medication [68 (34.5-163.5) minutes versus 65 (33-142) minutes, p=0.7328], and time to first continuous infusion [186 (124.2-571) minutes versus 160 (89.5-495) minutes, p=0.2236]. Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least one BZD before hospital arrival increased after publication of evidence of delays [41/81 (50.6%) versus 57/76 (75%), p=0.0018], and the odds ratio (OR) was also increased in multivariable logistic regression [OR=4.35 (95% confidence interval: 1.96-10.3), p=0.0005].Conclusion:Publication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least one BZD before hospital arrival.

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Section: Discussionmentioning

confidence: 75%

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confidence: 99%

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confidence: 99%

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Association of guideline publication and delays to treatment in pediatric status epilepticus

Fernández¹,

Abend

Amengual‐Gual

et al. 2020

Neurology

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“…This translated into median hospital charges per patient being substantially lower ($1459 vs $6980) (approximately $2021 vs $9670 in 2019 US dollars) with intranasal midazolam than with rectal diazepam 36 . Therefore, even if the literature is limited, relatively minor increases in the effectiveness of the initial treatments of SE may result in major improvements in downstream clinical outcomes and resource utilization 37,38 …”

Section: Discussionmentioning

confidence: 99%

“…36 Therefore, even if the literature is limited, relatively minor increases in the effectiveness of the initial treatments of SE may result in major improvements in downstream clinical outcomes and resource utilization. 37,38 It usually takes several decades from the time an actionable clinical research finding is discovered until it is widely implemented in clinical practice. 39,40 A recent meta-analysis showed that the acute mortality associated with SE has not changed substantially in children or adults in the last 30 years.…”

Section: F I G U R Ementioning

confidence: 99%

The burden of decisional uncertainty in the treatment of status epilepticus

et al. 2020

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Objective: Treatments for convulsive status epilepticus (SE) have a wide range of effectiveness. The estimated effectiveness of non-intravenous benzodiazepines (non-IV BZDs) ranges from approximately 70% to 90% and the estimated effectiveness of non-benzodiazepine antiseizure medications (non-BZD ASMs) ranges from approximately 50% to 80%. This study aimed to quantify the clinical and economic burden of decisional uncertainty in the treatment of SE. Methods: We performed a decision analysis that evaluates how decisional uncertainty on treatment choices for SE impacts hospital admissions, intensive care unit (ICU) admissions, and costs in the United States. We evaluated treatment effectiveness based on the available literature. Results: Use of a non-IV BZD with high estimated effectiveness, like intranasal midazolam, rather than one with low estimated effectiveness, like rectal diazepam, would result in a median (p 25-p 75

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Seizure emergency code strategy: Improving treatment times and hospital outcomes for patients with urgent epileptic seizures

Espinosa‐Jovel,

Riveros,

Valencia‐Enciso

et al. 2024

Epileptic Disorders

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ObjectiveTimely treatment is one of the most relevant prognostic factors in patients with urgent epileptic seizures. Despite the available evidence, treatment times remain suboptimal. The aim of this study was to demonstrate the impact of the “seizure code” in an emergency department, focusing on both treatment times and hospital outcomes of patients with urgent epileptic seizures.MethodsAn ambispective cohort study was conducted in the emergency department of a public hospital in Bogotá, Colombia. Treatment times and hospital outcomes were evaluated both before and after the implementation of the seizure code.ResultsA total of 336 patients were included (94 in the pre‐seizure code period and 242 in the post‐seizure code period). Both cohorts were comparable in terms of clinical and demographic baseline characteristics. After the implementation of the seizure code, in‐hospital treatment times improved among patients with status epilepticus and seizure cluster. For the group of patients with status epilepticus, the time from arrival to the first benzodiazepine decreased from a median of 100.5 min (IQR: 43–152.5) to a median of 20 min (IQR: 10–45) (p = .0063), and the time from arrival to the first non‐benzodiazepine antiseizure medication decreased from a median of 155 min (IQR: 49–194) to a median of 39 min (IQR: 25–57) (p = .0071). For the group of patients with seizure cluster, the time from arrival to the first non‐benzodiazepine antiseizure medication decreased from a median of 296 min (IQR: 112.5–409) to a median of 72 min (IQR: 46–111) (p < .001). The seizure code significantly decreased the risk of inappropriate benzodiazepine use (p = .0087), in‐hospital seizure recurrence (p < .001), in‐hospital mortality (p = .0074), and prolonged hospitalizations (more than 48 h) (p = .0475).SignificanceThe seizure code shortens the time to treatment, reduces the length of hospital stay, decreases the risk of inappropriate benzodiazepine use, and lowers both the in‐hospital seizure recurrence and in‐hospital mortality among patients with urgent epileptic seizures.

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Decreasing Seizure Treatment Time Through Quality Improvement Reduces Critical Care Utilization

Cited by 27 publications

References 27 publications

Association of guideline publication and delays to treatment in pediatric status epilepticus

Association of guideline publication and delays to treatment in pediatric status epilepticus

The burden of decisional uncertainty in the treatment of status epilepticus

Seizure emergency code strategy: Improving treatment times and hospital outcomes for patients with urgent epileptic seizures

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