Reducing Time to Electroencephalography in Pediatric Convulsive Status Epilepticus: A Quality Improvement Initiative
Lindsey A Morgan1, Brittany N Sprigg2, Dwight Barry3
1Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
Insights
Implementing process improvements significantly reduced electroencephalography (EEG) delays in pediatric convulsive status epilepticus (CSE) care. This enhances timely diagnosis and treatment for critically ill children requiring urgent EEG interpretation.
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.
Background:
Pediatric convulsive status epilepticus (CSE) is a neurological emergency utilizing electroencephalography (EEG) to guide therapeutic interventions. Guidelines recommend EEG initiation within one hour of seizure onset, but logistic and structural barriers often lead to significant delays. We aimed to reduce the time to EEG in pediatric CSE.
Methods:
From 2017 to 2022, we implemented process improvements, including EEG order sets with priority-based timing guidance, technologist workflow changes, a satisfaction survey, and feedback from key stakeholder groups, over five plan-do-study-act (PDSA) cycles. Seizure start time, time of EEG order, and time to EEG initiation were extracted. Time to interpretable EEG was determined from manual review of the EEG tracing.
Results:
Time from EEG order to interpretable EEG decreased by nearly 50%, from a median of 90 minutes to 48 minutes. There were clinically and statistically significant improvements in time from EEG order to EEG initiation, time from EEG order to interpretable EEG, and EEG start to interpretable EEG. Ongoing provider education and guidance enabled improvements, whereas a new electronic health care record negatively impacted electronic ordering. EEG technologists reported that they understood the importance of emergent EEG for clinical care and did not find that the new workflow caused excessive disruption.
Conclusions:
Timely access to EEG for pediatric patients with CSE can be improved through clinical processes that use existing devices and that maintain the benefits of full-montage EEG recordings. Similar process improvement efforts may be generalizable to other institutions to increase adherence to guidelines and provide improved care.
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