Abstracts

Rationale: Neurological assessment of a patient during seizures provides valuable information about the symptomatogenic zone in evaluation for epilepsy surgery. An appropriate seizure interview may potentially reduce the length of hospital stay and sometimes obviates the need for other ancillary tests. Under the guidance of a QI curriculum, a QI project was implemented to improve the quality of testing during seizures in the pediatric epilepsy monitoring unit at Cleveland Clinic. Methods: A multidisciplinary team that included- two epileptologists, epilepsy fellow, nursing manager, nurse educator, EEG technologist and a coach- was formed. The team participated in a QI course called SolVE (Solutions for Value Enhancement), a 12-week application based problem-solving training program offered at the Cleveland Clinic. Through a series of class room discussions and team brainstorming sessions, the team progressed through the PDSA (plan, do, study, act) cycle of improvement to identify the quality gap and implement appropriate interventions. For pre-intervention baseline data, 10 seizure videos of patients aged between 8 and 18 years of age who were not cognitively impaired were reviewed. Using a 16-item check list, the quality of testing during seizures was evaluated. Root cause analysis for suboptimal testing was performed by reviewing the seizure videos for missed items, and surveying the stake holders (nurses who perform the testing in the unit). A list of 26 causes was generated and grouped in 6 different categories: suboptimal knowledge, testing complexity, patient factors, staffing related, equipment errors and communication gap. Using a decision matrix, we elected to implement 4 interventions. These include: (i) developing an easy to use easily accessible seizure interview tool; (ii) Teaching the caregivers about various steps in testing; (iii) create a teaching video about the various steps of seizure testing; (iv) a badge-backer that visually displays the various items in testing. After intervention, ten seizure videos were evaluated with the 16-item check list (Table 1.) Results: At baseline, only one seizure out of ten seizures videos reviewed had 10 or more (of 16) items checked. Mean number of items checked at baseline was 5.1 per seizure. About 6 weeks after the implementation of the multiple interventions, 7 out of 10 seizures had more than 10 items checked and the mean number of items checked was 11.9 per seizure (Figure 1). Conclusions: Our project was successful in improving the testing during seizures in a pediatric epilepsy monitoring unit. Implementation of a structured process using a seizure interview tool for the assessment during the seizure improved the quality of testing. Use of a multidisciplinary team, organized approach using the various QI tools and effective engagement of stakeholders was instrumental for this successful project. Funding: None