Use of an Electronic Medical Record Alert to Prevent Iatrogenic Interventions in Patients With Psychogenic...

Seizures are a common presentation to the emergency department and the hospital setting. Psychogenic or functional seizures are often misdiagnosed as epileptic seizures or status epilepticus, and patients are subject to aggressive interventions including sedation, intubations, and prolonged hospital admissions. An electronic medical record (EMR) best practice alert (BPA) was implemented in 2016 for all patients with a confirmed diagnosis of psychogenic nonepileptic seizures (PNES) at Rush University Medical Center. It informs health care providers of the diagnosis and provides education on interacting with the patient's chart. This study evaluates the effectiveness of an EMR BPA in preventing iatrogenic interventions for patients with a diagnosis of PNES.

A retrospective chart review was performed on all patients who presented to Rush University Medical Center between January 2017 and December 2019 and had a PNES BPA triggered. Data on emergency department (ED) visits and inpatient admissions for these patients from the year before and the year after the first BPA trigger were compared. A Wilcoxon signed-rank test and McNemar test were used for analysis.

A PNES BPA was triggered in 178 patients. One hundred and forty-three (80%) were female. The mean age was 41 (18-81) years. There was a decrease in the number of ED visits; hospital admissions; intensive care unit (ICU) admissions; and interventions such as intubations and rescue benzodiazepine use in the year after the BPA was first triggered compared with the previous year (p < 0.05). No adverse events were identified in relation to the BPA.

This study demonstrates that the use of an EMR BPA can be safe and effective in preventing potential iatrogenic interventions and reducing acute health care utilization in patients with PNES. These BPAs can also be used as an educational tool to communicate the presentation, risks, and needs of these patients within the hospital setting.