National Audit of Seizure Management in Hospitals 2 (Nash2)

Abstract

Background NASH1 (National Audit of Seizure management in UK Hospitals) collected data in 2011 and fed back in 2012. It identified significant shortfalls and variability in the way that care was provided. Here we report the second round-NASH2. Methods NASH2 assessed the prior, immediate, and onward care of patients attending Emergency Departments with seizures. Sites provided anonymous data on 30 consecutive cases via a web-based database between June and September 2013. Results Data were collected from over 4,500 patients across 154 sites in the UK (mean age=47.1, 57% male). Results show considerable inter-site variability, with a few sites performing well to show good care is possible. Assessment on arrival was again inadequate, a proper neurological examination with plantar responses recorded in 34% , an attempt to gain an eyewitness description in 69% , and an ECG performed in 75% (IQR 65.9-86.7). Only 55% of first seizure patients were referred for any form of neurology specialist assessment, and less than half for known epilepsy. 45% had a previous attendance in the last 12 months. Conclusions Findings confirm unacceptable variability in the provision of care. Commissioners, primary, secondary and tertiary care, and the public must work together to commission and deliver better services.

Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase

“…In the current study people with primarily alcohol problems were excluded as a different nurse specialist service is responsible for their management at hospital. However, the NASH study 52 found that epilepsy with alcohol overuse was a frequent correlate of ED attendance. In the current study predictors of frequent attendance were lower confidence in managing epilepsy, a higher number of prescribed AEDs, more felt stigma, a higher number of baseline ED visits, greater seizure frequency and higher levels of depression and anxiety.…”

“…This is consistent with process evidence from a national audit suggesting that ED use offers little added value to care. 52 Using regression analysis we found that, in descending order of importance, less knowledge, more felt stigma, poorer medication management and greater seizure frequency predicted emergency visits before entering the study.…”

“…Previous studies from the UK and abroad describe attendance at EDs by PWE. 32,52,104,[126][127][128] These studies mainly focused only on the appropriateness of ED attendance and lack of benefit from EDs for PWE who attend in the context of continuing care. No study had trialled an intervention for PWE that specifically aimed to reduce ED use, or explored patients' own reasons for attending the ED.…”

“…165 The NASH has highlighted wide variations in standards of care, with, in particular, poor follow-up, communication and services for PWE attending EDs across the UK. NASH calls for more in-depth research and there is some momentum for hospitals to address the problems identified across the NHS.…”

“…NICE guidelines for epilepsy, 50 however, indicate that, when seizures are not controlled or treatment fails, it is expected that a patient will be referred to tertiary services for assessment. The 2012 UK-wide National Audit of Seizure Management in Hospitals (NASH) 52 showed that UK EDs initiated this for only one-third of PWE attending EDs.…”