Journal article
Reducing Time to Electroencephalography in Pediatric Convulsive Status Epilepticus: A Quality Improvement Initiative
Pediatric neurology, Vol.152, pp.169-176
03/2024
DOI: 10.1016/j.pediatrneurol.2024.01.006
PMID: 38295718
Abstract
Pediatric convulsive status epilepticus (CSE) is a neurological emergency utilizing electroencephalography (EEG) to guide therapeutic interventions. Guidelines recommend EEG initiation within one hour of seizure onset, but logistic and structural barriers often lead to significant delays. We aimed to reduce the time to EEG in pediatric CSE.
From 2017 to 2022, we implemented process improvements, including EEG order sets with priority-based timing guidance, technologist workflow changes, a satisfaction survey, and feedback from key stakeholder groups, over five plan-do-study-act (PDSA) cycles. Seizure start time, time of EEG order, and time to EEG initiation were extracted. Time to interpretable EEG was determined from manual review of the EEG tracing.
Time from EEG order to interpretable EEG decreased by nearly 50%, from a median of 90 minutes to 48 minutes. There were clinically and statistically significant improvements in time from EEG order to EEG initiation, time from EEG order to interpretable EEG, and EEG start to interpretable EEG. Ongoing provider education and guidance enabled improvements, whereas a new electronic health care record negatively impacted electronic ordering. EEG technologists reported that they understood the importance of emergent EEG for clinical care and did not find that the new workflow caused excessive disruption.
Timely access to EEG for pediatric patients with CSE can be improved through clinical processes that use existing devices and that maintain the benefits of full-montage EEG recordings. Similar process improvement efforts may be generalizable to other institutions to increase adherence to guidelines and provide improved care.
Details
- Title: Subtitle
- Reducing Time to Electroencephalography in Pediatric Convulsive Status Epilepticus: A Quality Improvement Initiative
- Creators
- Lindsey A. Morgan - University of WashingtonBrittany N. Sprigg - University of California, San DiegoDwight Barry - Seattle Children's HospitalJennifer B. Hrachovec - National Patient Safety FoundationEdward J. Novotny - University of WashingtonLisa F. Akiyama - University of WashingtonNicholas Allar - Seattle Children's HospitalJoshua K. Matlock - Seattle Children's HospitalLeslie A. Dervan - Seattle Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Pediatric neurology, Vol.152, pp.169-176
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.pediatrneurol.2024.01.006
- PMID
- 38295718
- ISSN
- 0887-8994
- eISSN
- 1873-5150
- Number of pages
- 8
- Language
- English
- Date published
- 03/2024
- Academic Unit
- Stead Family Department of Pediatrics; Neurology (Pediatrics)
- Record Identifier
- 9984701549802771
Metrics
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