Reducing Time to Electroencephalography in Pediatric Convulsive Status Epilepticus: A Quality Improvement Initiative

Area of Science:

• Neurology
• Medical Informatics
• Healthcare Process Improvement

Background:

• Pediatric convulsive status epilepticus (CSE) is a critical neurological emergency.
• Electroencephalography (EEG) is vital for guiding CSE treatment, with guidelines recommending initiation within one hour of seizure onset.
• Significant logistical and structural barriers frequently cause delays in initiating EEG for pediatric CSE.

Purpose of the Study:

• To reduce the time to EEG initiation and interpretation in pediatric patients experiencing CSE.
• To implement and evaluate process improvements aimed at overcoming barriers to timely EEG access.

Main Methods:

• A series of five plan-do-study-act (PDSA) cycles were conducted from 2017 to 2022.
• Improvements included optimized EEG order sets, revised technologist workflows, and stakeholder feedback.
• Data on seizure onset, EEG order time, and EEG initiation were collected and analyzed.

Main Results:

• The median time from EEG order to interpretable EEG decreased by nearly 50% (from 90 to 48 minutes).
• Statistically significant improvements were observed in time from EEG order to initiation, time to interpretable EEG, and EEG start to interpretable EEG.
• Provider education facilitated improvements, while a new electronic health record system presented challenges.

Conclusions:

• Clinical process improvements can effectively reduce EEG delays in pediatric CSE.
• These improvements utilize existing technology and maintain the quality of full-montage EEG recordings.
• Similar initiatives may be transferable to other institutions to improve guideline adherence and patient care.