To identify whether introducing a standardized ictal assessment improves the quality of information obtained during an Epilepsy Monitoring Unit (EMU) stay.

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 <8 years old, or had severe intellectual disability. For each assessment 8 parameters were evaluated for the 5 testing domains (level of consciousness, language, motor function, memory, and post-ictal behavior).

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.

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.