Santry Laura A, Giordano Kathryn, Mower Andrew, Hubbard Jennifer, Thomas James, Scott Rodney C, Chara Karina, Zent James, Zomorrodi Arezoo
From the Department of Pediatrics Division of Pediatric Emergency Medicine, Nemours Children's Health, Wilmington, Del.
Department of Pediatrics Divison of Neurology, Nemours Children's Health, Wilmington, Del.
Pediatr Qual Saf. 2025 Jan 10;10(1):e787. doi: 10.1097/pq9.0000000000000787. eCollection 2025 Jan-Feb.
Pediatric seizures account for approximately 1% of emergency department (ED) presentations. Laboratory evaluation and emergent electroencephalogram (EEG) are not indicated in patients with a new-onset, unprovoked, afebrile seizure with a normal physical examination. This study aimed to reduce unnecessary ED resource utilization.
Through plan-do-study-act cycles from March 2021 to July 2023, a multidisciplinary team implemented change concepts, including creating a clinical pathway and supporting order sets, scheduling outpatient EEGs from the ED, and automating messages to the neurology team to ensure patient follow-up. The primary outcome measure was the percentage of qualified patients who received an EEG in the ED. Secondary outcome measures were the percentage of patients who had ED complete blood counts or neurology consults, the room-to-discharge time in minutes, and healthcare cost per patient. The balancing measure was the 30-day ED bounce-back rate.
Thirty-four and 99 patients met the inclusion criteria for the baseline and implementation phases, respectively. ED EEGs decreased from 59% to 1%. Complete blood counts and neurology consults decreased from 50% to 16% and 90% to 31%, respectively. Room-to-disposition time decreased from 308 to 203.5 minutes. Preliminary healthcare cost per patient decreased by $630. The 30-day bounce-back rate increased from 0% to 8%.
Implementing a new-onset seizure pathway decreased ED resource utilization, shortened room-to-discharge time, and lowered healthcare costs.
儿科癫痫发作约占急诊科就诊病例的1%。对于新发、无诱因、无发热且体格检查正常的癫痫发作患者，无需进行实验室检查和紧急脑电图（EEG）检查。本研究旨在减少急诊科不必要的资源利用。
从2021年3月至2023年7月，一个多学科团队通过计划-执行-研究-行动循环实施了变革理念，包括创建临床路径和支持医嘱集、在急诊科安排门诊EEG检查，以及自动向神经科团队发送信息以确保患者得到随访。主要结局指标是在急诊科接受EEG检查的合格患者百分比。次要结局指标包括进行急诊科全血细胞计数或神经科会诊的患者百分比、从就诊到出院的时间（以分钟为单位）以及每位患者的医疗费用。平衡指标是30天急诊科复诊率。
分别有34例和99例患者符合基线期和实施期的纳入标准。急诊科EEG检查率从59%降至1%。全血细胞计数和神经科会诊率分别从50%降至16%，从90%降至31%。从就诊到出院的时间从308分钟降至203.5分钟。每位患者的初步医疗费用降低了630美元。30天复诊率从0%升至8%。
实施新发癫痫发作路径可减少急诊科资源利用，缩短就诊到出院的时间，并降低医疗成本。
