Implementation of a Pediatric Neurocritical Care Program for Children With Status Epilepticus: Adherence to
Isabella Herman1, Thao Nguyen2, See Wai Chan2
1Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Implementing a pediatric neurocritical care (PNCC) program significantly improved adherence to continuous electroencephalogram (cEEG) monitoring for pediatric status epilepticus (SE). This enhanced care reduced the time to cEEG initiation, improving patient outcomes.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neurophysiology
Background:
- Status epilepticus (SE) in children requires prompt diagnosis and management.
- Continuous electroencephalogram (cEEG) monitoring is crucial for detecting non-convulsive seizures in SE.
- Adherence to cEEG guidelines in pediatric neurocritical care settings can be challenging.
Purpose of the Study:
- To evaluate adherence to cEEG monitoring for pediatric status epilepticus (SE) before and after implementing a pediatric neurocritical care (PNCC) program.
- To assess the impact of a PNCC program on the timeliness of cEEG initiation in pediatric SE patients.
Main Methods:
- Retrospective review of pre- and post-intervention cohorts of children admitted to a pediatric intensive care unit (PICU) for SE.
- Implementation of a PNCC program including a dedicated neuro-ICU, expanded cEEG capacity, a criteria-based cEEG pathway, and provider education.
- Comparison of cEEG monitoring rates and time from PICU arrival to cEEG initiation between the pre-PNCC and PNCC eras.
Main Results:
- Adherence to American Clinical Neurophysiology Society (ACNS) criteria for cEEG monitoring increased from 42% in the pre-PNCC era to over 80% in the PNCC era.
- The interval between PICU arrival and cEEG initiation was significantly shorter in the PNCC era (138 min) compared to the pre-PNCC era (216 min).
- The PNCC program demonstrated high adherence rates (84%-97%) to ACNS criteria for cEEG monitoring.
Conclusions:
- The establishment of a PNCC program, incorporating care delivery restructuring, resource allocation, and education, significantly enhanced adherence to best practices for SE management.
- PNCC programs are effective in improving the utilization and timeliness of cEEG monitoring for pediatric SE.
- These improvements in care delivery are associated with better adherence to established guidelines for managing pediatric status epilepticus.
Objectives:
To describe adherence to continuous electroencephalogram (cEEG) monitoring as part of a pediatric neurocritical care (PNCC) program for status epilepticus (SE).
Design:
Retrospective review of pre- and postintervention cohorts.
Setting:
A pediatric referral hospital.
Patients:
Children admitted to the PICU for SE.
Interventions:
We restructured the care delivery model to include a pediatric neurointensive care unit (neuro-ICU) and expanded the cEEG capacity. We created a criteria-based cEEG pathway. We provided education to all providers including the nursing staff.
Measurements And Main Results:
The main outcomes were: 1) the percentages of children meeting American Clinical Neurophysiology Society (ACNS) criteria who underwent cEEG monitoring and 2) the time interval between PICU arrival and cEEG initiation. PICU admissions with the diagnosis of SE from May 2017 to December 2017 served as the baseline, which was compared with the same periods in 2018 to 2020 (PNCC era).There were 60 admissions in the pre-PNCC period (2017), 111 in 2018, 118 in 2019, and 108 in 2020. The percentages of admissions from each period that met ACNS criteria for cEEG monitoring were between 84% and 97%. In the pre-PNCC era, 22 of 52 (42%) admissions meeting ACNS criteria underwent cEEG monitoring. In the PNCC era, greater than or equal to 80% of the qualified admissions underwent cEEG monitoring (74/93 [80%] in 2018, 94/115 [82%] in 2019, and 87/101 [86%] in 2020). Compared with the pre-PNCC era, the neuro-ICU had a shorter interval between PICU arrival and cEEG initiation (216 min [141-1,444 min] vs 138 min [103-211 min]).
Conclusions:
The implementation of a PNCC program with initiatives in care delivery, allocation of resources, and education was associated with increased adherence to best care practices for the management of SE.
