Jackson Michele C, Vasquez Alejandra, Ojo Oluwafemi, Fialkow Alexandra, Hammond Sarah, Stredny Coral M, Antonetty Annalee, Loddenkemper Tobias
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, US.
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Int J Integr Care. 2022 Mar 31;22(1):28. doi: 10.5334/ijic.5598. eCollection 2022 Jan-Mar.
We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway.
We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children's Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management.
Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management.
Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.
我们旨在描述儿科患者的急性癫痫发作护理路径，并确定癫痫发作护理管理相关人员所遇到的障碍。我们还提出了干预措施，以弥合该路径中的这些护理差距。
我们构建了一个流程图，展示了波士顿儿童医院（BCH）儿科患者的急性癫痫发作护理路径。该流程图是根据从对BCH专家的非结构化访谈中收集的知识、通过实施质量改进癫痫发作日记对BCH患者护理管理的直接观察以及在BCH进行的三项研究结果设计而成，其中包括由儿科癫痫持续状态研究小组（一个多地点国际联盟）进行的前瞻性观察研究。我们还回顾了强调癫痫发作护理管理差距和策略的文献。
在流程图中，我们确定了护理人员、护理团队、住宿和教育机构遇到的29个护理差距，并提出了应对这些挑战的干预措施。流程图概述了患者在以下环境中的临床护理：1）住院前环境，定义为入院前的住宿和教育环境；2）BCH急诊科和住院环境；3）住院后环境，定义为出院或门诊就诊后的住宿和教育环境；4）BCH后续门诊环境，包括神经科、癫痫科和初级保健提供者诊所。癫痫发作的儿科患者的急性癫痫发作护理路径在急性癫痫发作护理管理中至少存在29个挑战。
识别急性癫痫发作护理路径中的护理障碍是在急性癫痫发作护理管理中实施可能影响患者结局的干预措施和策略的必要第一步。
