Decreasing Seizure Treatment Time Through Quality Improvement Reduces Critical Care Utilization.

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Clinical Pharmacology

Background:

• Status epilepticus in children requires rapid treatment to minimize morbidity and mortality.
• Current medication delivery for status epilepticus in hospitalized children is often delayed.
• Quality improvement (QI) initiatives are crucial for optimizing acute care delivery.

Purpose of the Study:

• To implement QI methodology to decrease treatment times for pediatric status epilepticus.
• To test the hypothesis that faster initial seizure treatment reduces seizure-related morbidity.

Main Methods:

• A tertiary care pediatric hospital utilized QI and statistical process control analysis in a non-ICU setting.
• Plan-Do-Study-Act cycles included revising nursing seizure response protocols, prioritizing intranasal midazolam, and optimizing medication accessibility.
• Standardization efforts involved developing educational modules and documentation tools.

Main Results:

• Median benzodiazepine treatment time for status epilepticus decreased from 14 to 7.5 minutes (P=0.01).
• The proportion of patients treated within 10 minutes increased from 39% to 79%.
• Intensive care transfers decreased from 39% to 9% (P<0.005), saving an estimated $2.1 million in hospital charges.

Conclusions:

• QI methodology successfully accelerated benzodiazepine treatment for pediatric status epilepticus.
• Faster treatment led to reduced critical care utilization and significant cost savings.
• Interventions were implemented without causing significant patient harm.