Decreasing Seizure Treatment Time through Quality Improvement Reduces Critical Care Utilization,,✯✯✯

Publication date: Available online 2 June 2018
Source:Pediatric Neurology
Author(s): Adam P. Ostendorf, Kelsey Merison, T. Arthur Wheeler, Anup D. Patel
ObjectiveRapid, effective treatment for status epilepticus reduces associated morbidity and mortality, yet medication delivery remains slow in many hospitalized patients. We utilized quality improvement (QI) methodology to improve treatment times for hospitalized children with status epilepticus. We hypothesized rapid initial seizure treatment would decrease seizure morbidity.MethodsWe utilized QI and statistical process control analysis in a non-intensive care setting within a tertiary care pediatric hospital. We performed Plan-Do-Study-Act cycles including (1) revising the nursing process for responding to seizures; (2) emphasizing intranasal midazolam over intravenous (IV) lorazepam; (3) relocating medications and supplies; (4) developing documentation tools and reinforcing correct processes; (5) developing and disseminating an online education module for residents and nurse practitioners; and (6) completing standardization to intranasal (IN) midazolam. This resulted in reduced utilization of critical care and mitigated hospital charges.ResultsSeventeen months after start, 66 seizures were treated with a benzodiazepine in a median (p25-p75) time of 7.5 minutes (5 to10) decreased from a baseline of 14 minutes (8 to30)(p=.01). The proportion of patients receiving a benzodiazepine in 10 minutes or less improved from 39% to 79%. The proportion of patients transferred to intensive care decreased from a baseline of 39% to 9% (p<.005), resulting in an estimated $2.1 million in mitigated hospital charges. Significant harm did not occur during the implementation of these interventions.ConclusionsChildren with status epilepticus were treated with benzodiazepines more rapidly and effectively following implementation of QI methodology. These interventions reduced utilization of critical care and mitigated hospital charges.



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