Abstracts

Rationale: Epilepsy surgery is the most efficacious treatment available to patients with drug-resistant localization-related epilepsy. The presurgical evaluation process is logistically complex and delays from initial referral to completion of epilepsy surgery are common. Such delays are not benign for epilepsy surgery candidates, who have a 0.9% annual risk of sudden unexpected death in epilepsy (SUDEP). Therefore our epilepsy program employed an epilepsy surgery nurse manager to expedite presurgical evaluation of patients with drug-resistant localization-related epilepsy. Methods: For this quality improvement initiative, we convened a multidisciplinary team to create a high-level process map and complete root cause analysis to identify sources of delay. At baseline, patients proceeded through the evaluation process without centralized oversight of their workup. Our intervention consisted of an epilepsy surgery nurse manager who coordinated the presurgical evaluation through 1) tracking patients discharged from the Epilepsy Monitoring Unit (EMU) and facilitating pre-surgical conference testing, and 2) facilitating post-surgical conference recommendations including coordinating follow-up with the neurosurgery schedulers. Our process metric was presentation in epilepsy surgical conference following EMU presurgical admission; our outcome metric was epilepsy surgery following presentation in epilepsy surgery conference. In a retrospective observational design, we compared a pre-intervention patient cohort undergoing evaluation from August to December 2015 and a post-intervention patient cohort undergoing evaluation from January to May 2016. Results: In the pre-intervention period, of the 20 patients found to be surgical candidates during their EMU admission, 7 patients (35%) were presented in surgical conference (median delay of 44 days, range 34-64). Of the 13 patients amenable to epilepsy surgery following epilepsy surgical conference, 0 patients underwent epilepsy surgery in that time period. In the post-intervention period, of the 19 patients found to be surgical candidates during their EMU admission, 13 (68%) were presented in surgical conference (median delay of 52 days, range 17-90). Of the 31 patients amenable to epilepsy surgery following surgical conference, 7 patients (23%) underwent epilepsy surgery (median delay of 40 days, range 6-118) in that time period. Conclusions: Employment of an epilepsy surgery nurse manager improved the throughput of epilepsy surgical candidates undergoing the presurgical evaluation process. Funding: none