Nurse Practitioner Boston Children's Hospital Boston, Massachusetts
Rationale: Pediatric patients with epilepsy account for a large portion of neurologic emergency department (ED) visits and unplanned hospital admissions, which may be related to barriers to specialty care. In an attempt to decrease seizure-related ED visits and unplanned hospitalizations, a nurse practitioner (NP) led urgent epilepsy clinic (UEC) was initiated to improve access to urgent epilepsy focused care. The aim was to provide care within two weeks of the identification of an urgent concern. Methods: Patients in need of urgent epilepsy care were screened by a registered nurse (RN) and determined to meet criteria for a UEC visit. Criteria included: a change in seizures or seizure medications; follow-up visit after a recent ED visit or unplanned hospitalization; medication side effects; or other acute neurological concerns. The RN recorded the reason for the visit and whether the encounter avoided an ED visit using the Care Coordination Measurement Tool (CCMT). We compared the number of seizure related ED visits and unplanned hospitalizations for pre and post intervention between May 2018 and February 2020. A correlation between a UEC visits and subsequent ED visits within 30 days was also evaluated. The number of days from scheduling to completion of UEC visits and NP routine follow-up visits was reviewed. For patients who utilized the UEC, the number of ED visits and unplanned hospitalizations for any reason for six months prior to initiation of UEC were identified. The percentage of patients who utilized the clinic who had equal or fewer ED visits and hospitalizations for the six months following the UEC visit was calculated. Results: Between May 2018 and February 2020, a total of 331 UEC visits were completed. Referral to the UEC was most commonly made for change in seizure activity (48%), followed by other neurological concern (16%), ED follow-up (15%), medication adverse effects (11%), and unplanned admission follow-up (6%). Compared to the one-year prior to the UEC, there was not a statistically significant reduction in seizure related ED visits or hospitalizations. There was a weak inverse correlation between seizure related ED visits and UEC visits, such that an increase in UEC visits was correlated with a decrease in ED visits. Furthermore, a decrease in UEC visits was correlated with an increase in ED visits (r = 0.059). The number of days from screening for an appointment to the completed NP UEC visit (median = 3) was less than the number of days from scheduling to completion of routine return NP visit (median = 23). Based on the CCMT completed by nursing at the time of the UEC visit screening, 73% of visits avoided an ED visit. When compared to the six months prior to UEC, patients who completed UEC visits had the same or fewer ED visits (88%) and unplanned hospitalizations (90%). Conclusions: NP driven UEC visits improve access to urgent care and may help reduce the number of ED visits and unplanned hospitalizations for patients in a Pediatric Epilepsy Program. While there was not a clear reduction in overall ED visits or unplanned hospital admissions, nursing reported avoiding ED visits by scheduling UEC appointments. Furthermore, the weak inverse correlation between UEC visits and ED visits suggests that an increase in UEC referrals may result in fewer ED visits. With initiation of the UEC clinic, most patients had equal or fewer ED visits and unplanned hospitalizations in the six months following their UEC visit. Funding: Please list any funding that was received in support of this abstract.: N/A
