Abstracts

Rationale: Recent UK surveys, NICE and SIGN national evidence based guidelines have highlighted continuing concerns regarding the diagnosis and provision of care for children and young people with epilepsies. Meaningful clinical audit of epilepsies is important but often difficult to achieve in practice. Standardised clinical audit and appraisal of health services may help direct epilepsy service networks. We aimed to develop and pilot practical clinical audit tools which could provide meaningful, standardised measures of quality of care. We consider the practical value of results obtained. Methods: The Children’s Epilepsy Workstream in Trent (CEWT) coordinated a regional audit of epilepsy care. Children presenting to paediatric services; acutely or non-acutely; with paroxysmal event(s); in whom an epileptic basis was suspected; assessed for the first time by a paediatric service; within a defined 10 week period (2004) were ascertained. A standardised audit proforma was applied retrospectively to casenotes. Data was anonymised and then inputted centrally into a spreadsheet template by the coordinating clinician. Methods of ascertainment, demographics, diagnoses, 12 clinical performance indicators, waiting times, and descriptors of service were defined for the whole cohort and each sub-cohort individually. Results: 4 hospital services were able to participate. 236 children seen with paroxysmal episodes were identified of which 65 met inclusion criteria. At first assessment 29 (45%) episode(s) were diagnosed as epileptic; 21 (32%) non-epileptic, and 15 (23%) uncertain. Diagnosis at 1 year was recurrent epileptic seizures (epilepsy) 22 (34%), of which 12 were commenced on anti-epileptic drug treatment (AEDs); 10 (15%) single epileptic seizures; 26 (40%) non-epileptic; and 7 (11%) uncertain. 12 performance indicators were calculated. For example 46% of children assessed met criteria for case notes evidence of appropriate history and examination; 100% of children prescribed AEDs at any time within the first year maintained a diagnosis of epilepsy at 1 year. 23% had evidence of contact with a specialist epilepsy nurse where appropriate. Conclusions: The target population was difficult to ascertain and community based services were not able to be represented. Performance indicators can be determined and act as broad ‘feedback’ for services. Results have aided development of a proposed service specification for commissioning services; regional guidelines and patient information; benchmarking of service provision and highlighted training needs. Future re-audit will contribute to evidence regarding how varying service models and service development may relate to quality of care.