Predictors for readmissions after video-EEG monitoring

Abstract

Objective: Identification of variables prognosticating 30-day readmission among adult patients admitted for video-EEG (VEEG) monitoring at a major epilepsy center.Methods: A retrospective cohort study was conducted, examining 865 consecutive admissions to the epilepsy monitoring unit (EMU) from January 2010 to June 2013. Data extracted from chart review included demographics, length of stay (LOS), seizure type(s), number of 30-day readmissions or emergency department (ED) visits and reasons for these, and patient and system/provider factors potentially contributing to the readmission.Results: Of 865 elective admissions for VEEG monitoring, 49 patients accounted for 33 readmissions and 40 ED visits within 30 days of discharge for an overall 30-day encounter rate of 7.0% after excluding those lost to follow-up; 9 patients had more than one ED visit or readmission. Statistically significant risk factors for urgent 30-day encounters included a history of nonepileptic seizures (NES) (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.4), a dual diagnosis of both epilepsy and NES (OR 5.9, 95% CI 3.0-11.8), an urgent index admission to the EMU (OR 2.5, 95%CI 1.4-4.8), and a shorter LOS of index hospitalization (median 4.0 days vs 5.0 days, p , 0.01). The most common contributing patient factors included active psychiatric symptoms, medically refractory epilepsy, and living alone; the most common hospitalization-related factors included antiepileptic drug (AED) treatment adverse events or AED adjustment.Conclusions: In addition to the presence of intractable epilepsy and shorter LOS, mental health comorbidities and the presence of NES were important risk factors for 30-day readmissions and ED visits in the epilepsy population. Therefore, proactively addressing mental health comorbidities may decrease urgent health care utilization after VEEG monitoring. United States hospital readmission rates within 30 days of discharge are estimated to approach 20%, and many readmissions are preventable.1 The Centers for Medicare & Medicaid Services (CMS) initiated the Hospital Readmission Reduction Program in 2012, which financially penalizes hospitals with excessive hospital readmissions, dramatically heightening our awareness of care transitions.2 The majority of hospitals in the United States have undertaken readmission reduction collaboratives given the national priority to reduce hospital readmissions. Neurologyspecific readmission reduction programs are increasingly becoming commonplace, 3,4 and CMS has moved forward with using 30-day readmission rates for stroke starting in fiscal year 2016. Patients face numerous challenges after hospital discharge, some of which may be unrelated to their initial reason for hospitalization, which can predispose them to readmission. 5 Patients with epilepsy represent a particularly vulnerable population given the complexity of medication regimens and safety instructions, the toxicity of therapies, the potential for breakthrough seizures in refractory epilepsy, and the high prevale...

An Undergraduate Research Fellowship Program to Prepare Nursing Students for Future Workforce Roles

“…In the past 5 years, the nursing students in the program have been coauthors with their mentors and other team members on more than two dozen poster and podium presentations at local, regional, and national nursing and health care conferences. In addition to the steady increase in the number of these presentations over the past few years, the impact and importance of the venues has increased, with students now beginning to appear as coauthors on research articles published in peer-reviewed journals (Caller, Chen, Harrington, Bujarski, & Jobst, 2014; Logan et al, 2014). Many have continued their interest and involvement in research either through active involvement in organizational initiatives or through completion or pursuit of a master's degree in nursing.…”

Does adherence to epilepsy quality measures correlate with reduced epilepsy‐related adverse hospitalizations? A retrospective experience

“…To improve the standardization of quality outpatient care for people with epilepsy (PWE), 1,2 in January 2011, the American Academy of Neurology (AAN) and the Physician Consortium for Performance Improvement (PCPI) established eight Epilepsy Quality Measures (EQMs) to be followed by neurologists who care for PWE. 3 The eight consensus quality measures included documentation of the following: (1) seizure type/frequency, (2) seizure etiology, (3) electroencephalography (EEG), (4) neurologic imaging, (5) surgical consultation for patients with intractable epilepsy, (6) patient counseling regarding side effects of antiepileptic drugs (AEDs), (7) safety counseling, and (8) women's health counseling. Despite the passage of 4 years since publication, a limited number of studies describe provider adherence to these recommendations.…”

“…[4][5][6] PWE are an exceptionally vulnerable population at risk for costly epilepsy-related adverse hospitalization (ERAH) due to complicated medication regimens, toxicity of therapies, risk of breakthrough seizures, and high rates of neuropsychiatric comorbidities. 7 Those with uncontrolled epilepsy have a higher risk of hospitalization due to a high rate of fractures, head injuries, emergency department visits, and longer hospital stays, resulting in higher total health care utilization costs than for well-controlled patients. 8 We hypothesized that adherence to these EQM would correlate with a reduced incidence of ERAH and improvement in seizure control.…”

Short burst Clobazam dosing at discharge from VEEG evaluation reduces re-presentation with seizures

“…Admission for monitoring is not without risks. Breakthrough seizures and status epilepticus after discharge post VEEG with AED reduction is a well-known complication [2][3][4][5]. In the literature this is reported to occur at a rate of approximately 3-7% [2][3][4][5].…”

“…Breakthrough seizures and status epilepticus after discharge post VEEG with AED reduction is a well-known complication [2][3][4][5]. In the literature this is reported to occur at a rate of approximately 3-7% [2][3][4][5]. There is a lack of high level evidence to define best practices in the EMU, both during the admission and on discharge [6].…”