Abstracts

Rationale: Hospitalizations and ED visits account for a large portion of the cost of care in children with established epilepsy. A 2009 study found the mean total health care costs for children with epilepsy were $6,379 compared to $1,032 for children without epilepsy. Previous studies have found that missed clinic appointments and frequent calls to triage nurses are variables associated with high ED and admission rates. In an attempt to decrease ED visits, we established an urgent clinic for children with established epilepsy. Methods: Children at risk for an ED visit or admission due to seizures were referred to the clinic by neurology staff. Criteria for referral included frequent ED visits, frequent or long phone calls to the triage nurses, parental anxiety, and missed appointments. Referrals were reviewed by an epilepsy nurse practitioner for appropriateness and then scheduled. Children were then seen in the clinic by an epilepsy nurse practitioner and, in most cases, by an epilepsy social worker. Factors influencing the need for the appointment and actions taken during the clinic visit were recorded. The number of ED visits was noted prior to and after the clinic visit. Data collection is ongoing. Results: 60 of 62 (97%) patients scheduled from August 2013 through March 2013 came to their appointment. Referral sources included phone triage nurses (45%), on call neurology residents and faculty (33%), neurology clinic staff (7%), social workers (7%), hospital follow up calls (4%), and school nurses (4%). 83% of patients were seen in the clinic within 5 days and 65% within 3 days of being referred. Factors triggering the referral included: need for education (45%), parental anxiety (42%), frequent ED visits (25%), change in seizure frequency or semiology (25%), missed appointments (23%), and frequent and long phone calls (13%). Common actions taken at the clinic visit included: parent education and counseling (100%), change in AED (38%), development of a seizure action plan (32%), suspicion of non-epileptic events (18%), need for long term video EEG monitoring (13%), and referral for epilepsy surgical evaluation (13%). Only 2 (3%) patients required hospital admission directly from the clinic. The mean number of ED visits per month for the group due to seizures decreased from 6 to 2.3 during the 3 months prior to and after the clinic visit. The overall number of ED visits by established epilepsy patients decreased by 33% from 49/month to 38/month after implementation of the clinic. Conclusions: An urgent clinic for children with established epilepsy is effective in reducing ED visits for seizures and improving adherence to outpatient clinic appointments for seizures. A 97% show rate when compared to the 84% average show rate in our other neurology clinics indicates that parents are more likely to keep appointments when they initiate the appointment at a time of need. Patient centered multi-disciplinary care at the time parents are ready to receive it reduces their dependence on the emergency room for epilepsy care.