Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Abstract

Background: Repeat attendances to emergency departments for seizures, impacts on the individual and burdens health care systems. We conducted a review to identify implementable measures which improve the management of people with epilepsy reducing healthcare costs and their supportive evidence. Methods: A scoping review design using suitable search strategy as outlined by PRISMA-ScR was used to examine seven databases: MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, HMIC and BNI. A manual search of the COCHRANE database and citation searching was also conducted. A thematic analysis was conducted to explore the context and reasons of emergency department attendance for seizures, particularly repeat attendances and the strategies and measures deployed to reduce repeat attendances. Results: Twenty-nine reports were included, comprising of a systematic review, a randomised control study, a multi-method study, quantitative studies (n = 17), qualitative studies (n = 6), an audit, a survey and a quality improvement project. Thematic analysis identified four broad areas for reducing repeat attendances. These were developing care pathways, conducting care and treatment reviews, providing educational interventions and role of ambulance staff. Conclusion: The findings indicate varied reasons for attendance at ED following seizure, including mental health and knowledge of seizure management and lack of education. Implementations of care pathways in ED have been found to reduce admission related costs.

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

“…The acceptability of an intervention to its intended recipients is a fundamental criterion for it to be well positioned to achieve its intended outcome (see ‘APEASE’ framework) [ [22] , [23] , [24] , [25] ]. The views of PWE and their family and friends (to whom care decisions are often delegated) have not yet been sufficiently explored in detail [ 26 ], yet, there are indicators that their views can vary substantially. Around 50% of PWE in the UK experience a seizure in the past year, but less than half attend ED ( Fig.…”

Decreasing Emergency Department Visits for Children With Epilepsy

“…Epilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. 1 Epilepsy or seizure care remains the most common neurologic condition that presents to an ED, with the majority of patients with an ED visit being less than 5 years of age. [2][3][4][5][6] In previous reports, seizure-related ED visits were frequently felt unnecessary by the patient, caregiver, or provider, with many of these visits being considered preventable.…”

“…[2][3][4][5][6] In previous reports, seizure-related ED visits were frequently felt unnecessary by the patient, caregiver, or provider, with many of these visits being considered preventable. 1,[7][8][9] ED visits lead to a high cost to the health care system 1,6,7,[10][11][12] in claims data; however, this cost may not capture the full financial burden and social impact of ED visits for seizure care. 13…”

“…Our sixth and last intervention focused on education. As inconsistency and at times lack of education on epilepsy and seizure emergency care were identified as factors in ED utilization based on previous studies, 1 clinic nursing staff provided enhanced education addressing this gap. The education was focused around the importance of adherence to daily medication and what to do when a child is having a prolonged seizure.…”

“…8,9 The results have been sustained. However, further ED visit reduction was considered achievable based on our understanding of the epilepsy population and successful interventions implemented by others in recent years, 1,14,22,23 specifically related to outpatient clinic visits and family education. A review was published detailing interventions that have been success in decreasing ED visits.…”