Epilepsy affects about 4% of the population. Patients with epilepsy present to the emergency department (ED) frequently with breakthrough seizures. Reducing these hospital visits can lower costs for both patients and hospitals along with reducing wait times for other ED patients. It also limits exposure to viruses like influenza and Covid-19.

Epilepsy is burdensome in ED settings because of higher health care resource utilization raising direct and indirect costs. A 2008 study showed that 1% of all ED visits comprised of seizures. Home seizure rescue medications can lower seizure duration and can prevent visits to the ED. Previous quality projects, performed at the Nationwide Children’s Hospital, included interventions like Urgent Epilepsy Clinic, Seizure Action Plan, and Abortive Seizure Medication Magnets. Care pathways in international studies showed that counseling and clear instructions for seizures decreased visits and hospital admissions.

We documented the number of ED visits for all epilepsy patients from March 2018 to February 2019.  In March 2019, we implemented the quality improvement metrics that included laminated cards with personalized seizure action plans and an EMR template for documentation of those plans. We then documented the number of ED visits for all epilepsy patients from March 2019 to February 2020.

A total of 91 patients were identified that underwent implementation of the seizure action cards and EMR documentation. An initial total of 50 ED visits dropped to 29 visits post-implementation, a relative improvement of 42%. The average visits per patient dropped from 0.556 to 0.322. The average reduction of 0.23 visits was statistically significant based on a two-tailed paired t-test (p=0.025).

Based on our study, simple interventions can lead to a remarkable decrease in seizure-related ED visits over a 1-year follow up period. Further research is warranted to specifically evaluate the effect of these measures on seizure-related hospital admission rates.