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Reduction of emergency department visits using an urgent clinic for children with established epilepsy
Anup D Patel1, Debbie Terry1, Jayne Pacheco Moore1
1Division of Neurology (ADP, DT), Department of Pediatrics and Neurology (JPM, JS, DMC), and Quality Improvement (EGW), Nationwide Children's Hospital; Department of Pediatrics (ADP), The Ohio State University College of Medicine, Columbus; and Department of Pediatrics and Neurology (ZMG), Weill Cornell, New York, NY.
Insights
An urgent epilepsy clinic (UEC) for children reduced emergency department (ED) visits for seizures. This epilepsy management approach improved patient appointment adherence, showing promise for pediatric epilepsy care.
Area of Science:
- Pediatric Neurology
- Healthcare Management
- Epilepsy Care
Background:
- Emergency department (ED) visits and hospitalizations represent significant costs in established epilepsy care.
- An urgent epilepsy clinic (UEC) was established to mitigate seizure-related ED visits in pediatric patients.
- The UEC aimed for a 30% reduction in ED visits and a 10% decrease in unplanned hospitalizations within 3 months post-appointment.
Purpose of the Study:
- To evaluate the impact of an urgent epilepsy clinic (UEC) on emergency department (ED) utilization for children with epilepsy.
- To assess changes in adherence to outpatient appointments following UEC interventions.
- To explore the potential for cost savings in pediatric epilepsy management.
Main Methods:
- Children at high risk for ED visits or hospitalizations were referred to the UEC, staffed by a nurse practitioner and social worker.
- Data collected included factors necessitating appointments and interventions provided.
- Cost-effectiveness analysis was incorporated into the study design.
Main Results:
- The UEC served 317 patients between October 2013 and July 2015.
- Appointment completion rates were higher in the UEC (93%) compared to general neurology clinics (84%).
- Eighty-three percent of patients received UEC appointments within 5 days of referral, with a significant decrease in ED visits post-appointment.
Conclusions:
- The UEC model demonstrated an association with reduced ED visits for pediatric epilepsy seizures.
- Improved adherence to outpatient appointments was observed in children attending the UEC.
- Further research is recommended to ascertain cost-effectiveness and compare health outcomes with non-UEC populations.
Background:
Emergency department (ED) visits and hospitalizations account for a large portion of the cost of care in people with established epilepsy. In an attempt to decrease seizure-related ED visits, we created an urgent epilepsy clinic (UEC) for children with epilepsy. Our aim was to decrease ED visits for patients seen in the clinic by 30% and decrease unplanned hospitalizations by 10% 3 months following an appointment.
Methods:
Children at risk for an ED visit or unplanned hospitalization were referred and seen by a nurse practitioner and social worker. Factors influencing the need for the appointment and actions taken were recorded. Cost savings were also calculated.
Results:
A total of 317 patients were seen in the UEC clinic from October 2013 to July 2015. Ninety-three percent of scheduled patients completed their appointment, compared to 84% in other neurology clinics. Eighty-three percent of patients were seen in the clinic within 5 days of the referral. Children were significantly less likely to come to the ED in the 3 months after an appointment compared to the 3 months before.
Conclusions:
An urgent clinic for children with established epilepsy was associated with a reduction in ED visits for seizures and improved adherence to outpatient clinic appointments for seizures. Further research is needed to evaluate the cost-effectiveness of UECs, and to compare health services and clinical outcomes to those of children without access to such services.
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