Education Research: Epilepsy Monitoring Unit Staff Education Using a High-Fidelity Manikin: A Pre-Post Intervention Study.

BACKGROUND AND OBJECTIVES

Given the inherent risks of seizure provocation in the epilepsy monitoring unit (EMU), both miscommunication and incomplete training about the importance of when and why certain measures are taken can cause critical gaps in care for patients in an especially vulnerable state. To provide a framework that would help minimize these potential pitfalls, our objectives were 2-fold: (1) identify deficits in EMU safety and assessment using a checklist of predetermined items, including key measures essential to the care of EMU patients and (2) develop a simulation training program to address these deficits with education for staff on optimal practices.

METHODS

After creation of an EMU safety checklist, authors retrospectively reviewed video from 12 consecutive patients (time zero; T0) admitted to the Baylor St. Luke's EMU to assess checklist compliance and seizure response times (both electrographic and clinical). EMU staff were then trained in small teams with the help of a simulation program developed using a high-fidelity manikin. After training was complete, EMU practices and response times were reassessed in short-term (T1) and long-term (T2) follow-up intervals.

RESULTS

When all 3 groups were compared, significant behavioral improvements (Kirkpatrick level 3) were seen in several critical evaluation and safety measures. Statistically significant improvements from T0 to T1 ( < 0.05) were seen in orientation assessment, speech assessment, motor assessment, oxygen administration, and vital sign collection. Score improvement persisted at T2 but showed a relative decline over time in 11 of 14 measures.

DISCUSSION

Education of staff in the EMU is paramount to ensure appropriate assessment of the seizure semiology and patient safety measures. Implementation of a novel simulation-based education platform demonstrated wide-ranging improvements in staff performance of safety and testing measures. Stratification between short-term and long-term assessment periods shows that while many categories showed overall improvement, regular training may be needed to sustain improvements in assessment and patient safety. Multicenter longitudinal studies assessing the efficacy of this or similar interventions should be performed to identify best patient practices.