Abstracts

Rationale: The changing landscape of US healthcare and insurance results in increased emergency room (ER) evaluations and inpatient evaluations by physicians who are not responsible for a patient's long-term care. For patients with epilepsy (PWE), this may result in redundant testing with increased medical costs. We wished to evaluate ER utilization by PWE, evaluate what ER imaging resources were performed, and what ER discharge plan was formulated. Methods: Patients presenting to our institution's ER for evaluation of "seizure, convulsion, spell with fall, epilepsy or syncope" in 2015 were reviewed. Of patients discharged from the ER, 10% of charts were randomly sampled for the following: number and reason of ER visits in 2015; call to treating outpatient physician; imaging; medications at presentation and discharge; discharge follow-up instructions; and if identified, patients who had successful follow-up. Results: In 2015, 5221 patients presented to our hospital's ER with a neurologic complaint, of which 891 patients (17%) had the conditions specified in our sample cohort. Of this sample, 594 were discharged from the ER and 57 (10%) of these charts were selected at random for review. 28% of patients presented for the same complaint 2-12 times. Prior neurologic outpatient care was provided by a Minnesota Epilepsy Group (MEG) physician in 51% of cases, no neurological ongoing care in 30%, or by other neurologist in 19%. 31% of 57 patients received neuroimaging with 17 patients having a CT and an MRI in 1, with 3 patients receiving repeated CTs. Admissions to hospital occurred for 8 patients and 3 of these patients had >1 admission. There were a total of 12 admissions over the year. The table lists factors contributing to ER visits. Directions for a post ER neurologic follow-up visit (PNV) was not documented in the EMR in 43% of the 57 cases, and only successfully accomplished in 41% of the whole group. Of the 29 MEG patients, successful PNV occurred in 73%. Conclusions: PWE presented to our ER for a variety of reasons, not all of which were medical emergencies. The development of strategies to avoid unnecessary ER visits and to ensure PNV are critical to this population. Resources to assist in the unique psycho-social problems associated with homelessness and group home domiciles offer an opportunity to reduce such visitations and to improve PNV. This review demonstrated unnecessary CT scanning and inadequate discharge planning in a plurality of patients. Improved medication supervision and administration, home emergency plans with rescue protocols, and aid in transportation are among some of the improvements in care that may decrease this population's ER recidivism. Although having protocols for "seizure care" in the ER may expedite the time line of care and reduce variation, it may also increase unnecessary evaluations, treatment and imaging, thus increasing the length of time in the ER and slowing the ER throughput while increasing the costs and not contributing to better patient outcomes. Funding: None.