Standardized Ictal Assessment: Improving the Quality of an Epilepsy Monitoring Unit (2018)

Objective: To identify whether introducing a standardized ictal assessment improves the quality of information obtained during an Epilepsy Monitoring Unit (EMU) stay. Background: The utility of long term video-EEG monitoring to characterize events and localize seizures is well established. Analysis of electrographic and clinical information from recorded events informs the clinician to provide the optimal treatment. However, the unpredictable and variable nature of seizures limits the accuracy and detail of ictal assessments. Like the NIHSS used in the assessment of stroke, using a standardized observational tool during ictal assessments may improve accuracy. To date, no standardized tool for ictal assessments has been developed. Design/Methods: The local RSRB at the University of Rochester approved this study. Consecutive patients admitted to the EMU for two consecutive months were screened for the presence of “event” button triggered ictal assessments. Patients were excluded if they were After the two months, there was a nursing staff quality improvement intervention; nurses had didactic training regarding ictal assessments and were provided a simple ictal assessment card to attach to ID badges as a reminder. Ictal assessments were again analyzed regarding their completeness over the following month. Results: In the pre-QI group 34 patients had 96 ictal assessments performed. The post-QI group 12 patients had 62 events ictal assessments performed. The quality of the ictal assessments performed improved in the post-QI group than in the pre-QI group (68% vs. 45%). The improvement persisted over all the individual domains except for the post-ictal behavior domain which was unchanged. Conclusions: Providing medical staff with formal didactic training and a simple standardized ictal assessment form improves the quality of the ictal assessments performed in the EMU. Disclosure: Dr. Hanrahan has nothing to disclose. Dr. Liu has received research support from SKLife and UCB as Principal Investigator for studies..