Epilepsy Fellow Beth Israel Deaconess Medical Center Harvard Medical School
Rationale: To improve referral of patients with drug resistant epilepsy and women with epilepsy who are currently or planning to become pregnant from Kentucky Neuroscience Institute (KNI) resident clinic to epilepsy clinic. Drug resistant epilepsy, as defined by the International League against Epilepsy is a failure of adequate trials of two tolerated and appropriate anti-seizure medications (ASM). Part of the epilepsy quality core measures are ensuring that patient are appropriately referred to epilepsy clinic for evaluation by an epileptologist. On initial evaluation of resident clinic, none of the patients with drug resistant epilepsy or women with epilepsy seen in resident clinic in a three-month period were appropriately referred to Epilepsy clinic. Methods: A referral template was created in concert with the epilepsy team for referrals from resident clinic to the Epilepsy clinic. Lectures were given to incoming and current residents regarding appropriate patients and the process of referral. The clinic schedules for the adult neurology residents were then retrospectively reviewed from August 2019 through October 2019. The patient’s encounter documentation was further reviewed by two abstractors to determine whether the patient met the criteria for referral to epilepsy clinic which included patients with drug resistant epilepsy, those with neurostimulation, and women with epilepsy who are currently or were planning to become pregnant. If the patient met criteria for referral, it was then determined whether or not they had been referred to the Epilepsy Clinic. This data was then analyzed by both abstractors. The data was then compared to the pre-intervention data from patients seen in resident clinic from July 2018 until September 2018. Results: In the pre-intervention data from July 2018 until September 2018, there were seven patients that per the quality measures should have been referred to Epilepsy clinic, and it was found that 0 were referred. After the intervention, there were eight total patients identified as meeting criteria for referral to epilepsy clinic, of which five were referred (62.5%). Of note, 1/8 (12.5%) were pregnant during the clinic appointment. While 2/8 (25%) had neurostimulation with vagus nerve stimulators. There was found to be 7/8 (87.5%) on two or more antiseizure medications during the appointment. Conclusions: In resident clinic, for all patients who were appropriate for referral to Epilepsy Clinic, 62.5% were referred which is an improvement after the intervention when compared to 0% of patients in the initial data collection period. While not all patients who should be referred to Epilepsy clinic were referred, there is a significant improvement after implementation of a referral template and resident education. Beyond ASM, patients with drug resistant epilepsy, when identified correctly, may benefit from surgical evaluation, drug trials or device placement (vagus nerve stimulator or responsive neurostimulator) offered in the epilepsy clinic. Given the improvement in referrals, ongoing resident education about appropriate patients and referral pathways should be continued. Funding: Please list any funding that was received in support of this abstract.: None
