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Protocol-Driven Management of Convulsive Status Epilepticus at a Tertiary Children's Hospital: A Quality Improvement
Gina Cassel-Choudhury1, Jules Beal2, Neha Longani3
1Division of Critical Care, Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, NY.
Insights
Implementing a standardized protocol significantly reduced the time to administer second-line anti-seizure medication for convulsive status epilepticus. This quality improvement initiative aimed to improve emergency care for pediatric patients experiencing seizures.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Quality Improvement Science
Background:
- Convulsive status epilepticus (CSE) is a critical medical emergency requiring prompt intervention.
- Delayed treatment of CSE can lead to refractory status epilepticus, increasing morbidity.
- Standardized protocols are essential for optimizing emergency medical care delivery.
Purpose of the Study:
- To reduce the time to administer second-line anti-seizure medication (ASM) in pediatric patients with CSE.
- To implement a standardized treatment protocol for CSE within a tertiary care children's hospital.
- To evaluate the impact of the protocol on time to second-line ASM and total seizure duration.
Main Methods:
- A quality improvement project utilizing Plan-Do-Study-Act cycles was conducted.
- A multidisciplinary team developed and implemented a standardized CSE treatment protocol.
- Key interventions included protocol dissemination, Pyxis system integration, and electronic order set creation.
Main Results:
- Analysis included 78 pediatric patients (41 baseline, 37 post-intervention).
- Median time to second-line ASM administration decreased significantly from 52 to 21 minutes (p=0.001).
- Total seizure time showed a trend toward reduction (65 to 31 minutes, p=0.09).
Conclusions:
- A standardized treatment protocol effectively reduced the time to administer second-line therapy for CSE by 60%.
- The protocol implementation demonstrated a significant improvement in the timeliness of emergency care for CSE.
- While not statistically significant, a reduction in total seizure time was observed, warranting further investigation.
Objectives:
Convulsive status epilepticus is a medical emergency. Prompt treatment has been shown to decrease progression to refractory convulsive status epilepticus. We aimed to reduce time to second-line anti-seizure medication through implementation of a standardized treatment protocol.
Design:
Quality improvement project. We constructed a multidisciplinary team and completed Plan-Do-Study-Act cycles to achieve the project aim.
Setting:
A tertiary care children's hospital.
Patients:
Patients presenting to the Children's Hospital at Montefiore emergency department with convulsive status epilepticus or new-onset seizures during admission to Children's Hospital at Montefiore.
Interventions:
Implementation of a standardized treatment protocol, uploading the protocol to the hospital's intranet, adding anti-seizure medications to the hospital's Pyxis system, and creating a standardized convulsive status epilepticus order set in the electronic medical record. The primary outcome measure was time from order to administration of second-line anti-seizure medication, and secondary outcome was total seizure time.
Measurements And Main Results:
Seventy-eight patients were analyzed, including 41 from the baseline period (January 2014 through June 2015) and 37 from the postintervention period (July 2015 through December 2016). The median time to administration of second-line anti-seizure medication decreased from 52 to 21 minutes (p = 0.001) and total seizure time from 65 to 31 minutes (p = 0.09).
Conclusions:
A standardized treatment protocol for convulsive status epilepticus decreased time to administration of second-line therapy by 60%, but there was no statistically significant decrease in total seizure time.